Abstract
Hypovitaminosis D is a prevalent problem in the general population and very common in children; related to different pathologies or factors such as the use of antiepileptic drugs (MAEs), mainly those enzymatic inducers of cytochrome P450, broadly related with bone health. Reason why this study seeks to determine the distribution of vitamin D insufficiency in children with epilepsy in pharmacological treatment and to establish associated factors based on sociodemographic, clinical, and therapeutic characteristics. Methodology: descriptive, crosssectional, retrospective study with 103 patients with epilepsy in management with MAEs, attending the neuropaediatric consultation in a third-level hospital, information was taken from the medical records of children between 0 and 18 years of age during January 2016 and June 2019. A multivariate model was built in relation to the presence of vitamin D insufficiency and its normal values. Results: 44.7% of patients had vitamin D insufficiency, while 6.8% had deficiency, of which 4 had a history of fractures. A statistically significant association with insufficiency was found in patients residing in rural areas (ORa=4.2 (IC95=1.3-13.4) p=0.013), they belong to a low socio-economic level (Ora=2.9 (95% CI=1.1-77) p=0.030) and suffering from refractory epilepsy (Ora=3.1 (95% CI=1-8.7) p=0.033). Conclusions: hypovitaminosis D is frequent in a patient with epilepsy under pharmacological management with MAE. Insufficiency was associated with refractory epilepsy, low socioeconomic status and coming from rural areas, so routine monitoring of vitamin D levels is recommended in those patients with deficits. MÉD.UIS.2022;35(1): 71-9
References
Battault S, Whiting SJ, Peltier SL, Sadrin S, Gerber G, Maixent JM. Vitamin D metabolism, functions and needs: from science to health claims. Eur J Nutr. 2013;52(2):429-41.
Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics. 2009;124(3):362-70.
Harijan P, Khan A, Hussain N. Vitamin D deficiency in children with epilepsy: Do we need to detect and treat it?. J Pediatr Neurosci. 2013;8(1):5-10.
Holick MF. Vitamin D: extraskeletal health. Endocrinol Metab Clin North Am. 2010;39(2):381-400.
Offermann G, Pinto V, Kruse R. Antiepileptic drugs and vitamin D supplementation. Epilepsia. 1979 Feb;20(1):3-15. Disponible en: https://pubmed.ncbi.nlm.nih.gov/217680/.
Millichap JG. Vitamin D Insufficiency in Children with Epilepsy. Pediatr Neurol Briefs [Internet]. 2010;24(6):45. DOI: https://doi.org/10.15844/pedneurbriefs-24-6-6.
Fraser LA, Burneo JG, Fraser JA. Enzyme-inducing antiepileptic drugs and fractures in people with epilepsy: A systematic review. Epilepsy Res [Internet]. 2015 Oct;116:59-66. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26354168/.
Habeeb S, Hameed R. 25-hydroxy vitamin D in children with epilepsy in Basra. Int. J. Curr. Res [Internet]. 2017; 9(9):57788-92 Disponible en: https://www.journalcra.com/article/25-hydroxy-vitamin-d-level-children-epilepsy-basra.
Souverein PC, Webb DJ, Petri H, Weil J, Van Staa TP, Egberts T. Incidence of fractures among epilepsy patients: a populationbased retrospective cohort study in the General Practice Research Database. Epilepsia. 2005;46(2):304-10.
Lee SH, Yu J. Risk factors of vitamin D deficiency in children with epilepsy taking anticonvulsants at initial and during followup. Ann Pediatr Endocrinol Metab. 2015;20(4):198-205.
Fong CY, Riney CJ. Vitamin D Deficiency Among Children With Epilepsy in South Queensland. J Child Neurol. 2014;29(3):368-73.
Shellhaas RA, Barks AK, Joshi SM. Prevalence and Risk Factors for Vitamin D Insufficiency Among Children With Epilepsy. Pediatr Neurol. 2010;42(6):422-26.
Oden Akman A, Tumer L, Hasanoglu A, Ilhan M, Cayci B. Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey. Pediatr Int. 2011;53(6):968-73.
Karaoğlu P, Polat Aİ, Ayanoğlu M, Yiş U, Hız S. Evaluation of vitamin D status in children with refractory epilepsy. Journal of Dr. Behcet Uz Children’s Hospital [Internet]. 2014;4(3):167-170. DOI: https://doi.org/10.5222/buchd.2014.167.
Lee YJ, Park KM, Kim YM, Yeon GM, Nam SO. Longitudinal change of vitamin D status in children with epilepsy on antiepileptic drugs: Prevalence and risk factors. Pediatr Neurol [Internet]. 2015;52(2):153-159. DOI: https:/doi.org/10.1016/j.pediatrneurol.2014.10.008.
Nettekoven S, Ströhle A, Trunz B, Wolters M, Hoffmann S, Horn R, et al. Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy. Eur. J. Pediatr [Internet]. 2008;167(12):1369-1377. DOI: https://doi.org/10.1007/s00431-008-0672-7.
김수범 Su Beom Kim 신은규 Eun Kyu Shine 정기택 Kee Taig Jung. Original Article: 민영건강보험하에서 의료수요의 가격탄력성에 관한 실증 분석 -법정본인부담금 보장금지 정책을 중심으로. 의료경영학연구 [Internet]. 2010;4(1):1-7. http://kiss.kstudy.com/journal/thesis_name.asp?tname=kiss2002&key=3183676.
Aksoy A, Müjgan Sönmez F, Deger O, Hosver I, Karagüzel G. The effects of antiepileptic drugs on the relationships between leptin levels and bone turnover in prepubertal children with epilepsy. J Pediatr Endocrinol [Internet] Metab. 2011 [citado 6 de mayo 2022];24(9-10):703-708. Disponible en: https://www.degruyter.com/document/doi/10.1515/jpem.2011.019/html.
Teagarden DL, Meador KJ, Loring DW. Low vitamin D levels are common in patients with epilepsy. Epilepsy Res [Internet]. 2014 [citado 6 de mayo 2022];108(8):1352-1356. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4149948/.
Nicolaidou P, Georgouli H, Kotsalis H, Matsinos Y, Papadopoulou A, Fretzayas A, et al. Effects of anticonvulsant therapy on vitamin D status in children: Prospective monitoring study. J Child Neurol [Internet]. 2006 [citado 6 de mayo 2022];21(3):205-209. Disponible en: https://journals.sagepub.com/doi/10.2310/7010.2006.00050?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&.
Cansu A, Yesilkaya E, Serdaroǧlu A, Hirfanoğlu TL, Camurdan O, Gülbahar O, et al. Evaluation of Bone Turnover in Epileptic Children Using Oxcarbazepine. Pediatr Neurol [Internet]. 2008 [citado 6 de mayo 2022];39(4):266-271. Disponible en: https://www.sciencedirect.com/science/article/pii/S0887899408003214?via%3Dihub.
Baek J, Seo Y, Kim G, Kim M, Eun B. Vitamin D Levels in Children and Adolescents with Antiepileptic Drug Treatment. Yonsei Med J. 2014;55(2):417-421. DOI: https://doi.org/10.3349/ymj.2014.55.2.417.
Al Khalifah R, Hudairi A, Al Homyani D, Hamad MH, Bashiri FA. Vitamin D supplementation to prevent Vitamin D deficiency for children with epilepsy: Randomized pragmatic trial protocol. Medicine. 2018;97(40). DOI: https://doi.org/10.1097/MD.0000000000012734.
Kalueff A V, Minasyan A, Tuohimaa P. Anticonvulsant effects of 1,25-dihydroxyvitamin D in chemically induced seizures in mice. Brain Res Bull. 2005;67(1-2):156-160. DOI: https://doi.org/10.1016/j.brainresbull.2005.06.022.
Mikati MA, Dib L, Yamout B, Sawaya R, Rahi AC, Fuleihan GE-H. Two randomized vitamin D trials in ambulatory patients on anticonvulsants: Impact on bone. Neurology. 2006;67(11): 2005- 14. DOI: https://doi.org/10.1212/01.wnl.0000247107.54562.0e.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30. DOI: https://doi.org/10.1210/jc.2011-0385.
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