Post on 29-Apr-2023
Vitamin-D levels in childrenand adolescents underantiepileptic therapyMafalda Ferreira Santos1, Jéssica França Sousa1, Joana Campos2, Dora Gomes2, Nuno Stattmiller Andrade2
1. Pediatric Resident; 2.Pedriatic Assistant
Serviço de Pediatria Médica
Centro Hospitalar Tondela - Viseu
Portugal
● Vitamin D sufficiency plays an important role in effective bone
mineralization, providing bone mass accrual during childhood.
● The major source of vitamin D is sunlight exposure.
● In addition, its levels are influenced by several other
important factors including
● dietary vitamin D and calcium intake
● physical activity
● several types of medications.
INTRODUCTION
● Antiepileptic drug therapy (AET) may lead to various adverse
effects
● long-term use being a significant risk factor for vitamin D
deficiency in epileptic children
● important to clarify the need for treatment and prevention in
these patients.
● In our study, vitamin D status [measured through 25-
hydroxyvitamin D (25(OH)D3)] was evaluated in a pediatric
population under antiepileptic therapy, to determine the
prevalence and risk factors of vitamin D deficiency.
INTRODUCTION
● A prospective, descriptive study was conducted from January
2018 up to December 2019 – 24 months.
● Inclusion criteria: pediatric patients diagnosed with epilepsy and
under AET lasting for more than one year followed in a Pediatric-
Epilepsy consultation of an urban Hospital.
● Exclusion criteria: ongoing therapy with vitamin D or for the
previous 6 months.
● Potential risk factors for vitamin-D deficiency were assessed
● Vitamin-D deficiency was defined as 25(OH)D3 < 20 ng/mL, while
insufficiency was defined as 25(OH)D3 between 21-29 ng/mL.
METHODS
RESULTS• 54% male/46% female• Age Range: 7 to 17 years old• Mean Age: 12,44 ± 3,49 years
41 PATIENTS
FIRST ASSESSMENT SECOND ASSESSMENT
Vitamin D deficiency25(OH)D3 = < 20 ng/mL
53,66% (n=22) 46,34% (n=19)
Vitamin D Insufficiency25(OH)D3 = 21 and 29 ng/mL
34,15% (n=14) 43,90% (n=18)
Regular Value of Vitamin D25(OH)D = > 30 ng/mL
12,19% (n=5) 9,76% (n=4)
● The mean baseline of 25(OH)D3 level has decreased from:
19,52 ± 6,91ng/ml to 17,61 ± 7,33 ng/mL.
● The mean change in the 25(OH)D3 levels was
-1.8 ng/mL.
RESULTS
RESULTSMedium Value of
25(OH)D3 (ng/mL)p value
Body Mass Index
(BMI) Percentile
< P85 20,39 ± 1,4 P < 0,23
≥ P85 16,67 ± 2.1 p < 0,01
AET
Duration
< 3 years 21,65 ± 3,5 p < 0,44
3 – 5 years 21,01 ± 3,9 p < 0,51
> 5 years 19,58 ± 9.1 p < 0,01
Type of AET instituted
Nonenzyme-
inducing
antiepileptic drugs
20,94 ± 9,1 p < 0,74
Enzyme-inducing
antiepileptic drug
16,96 ± 7,9 p < 0,03
Type of TherapyMonotherapy 20,98 ± 6,0 p < 0,57
Polytherapy 17,22 ± 7,6 p < 0,01
● Factors associated with a significant lower level of
25(OH)D3 (p<0,05):
• Polytherapy
• AET duration over 5 years
• BMI > P85
• Therapy with carbamanzepine
● There were no significative diference in the levels of
25(OH)D3 concerning the age, gender and MRI findings.
RESULTS
CONCLUSION
● Serum levels of vitamin D
● particularly low in almost all epileptic patients
● decrease of mean baseline 25(OH)D3 level during follow-up
● This study emphasizes the need of regular monitoring of
vitamin D levels during the treatment of childhood epilepsy
● Supplementation with cholecalciferol when deficiency in 25-
hydroxyvitamin D is recomended.
● This approach is in line with the principle of not only treating
epileptic seizures, but patients with epilepsy.
● Potential risk factors for vitamin D levels in medium- and longterm use ofantiepileptic drugs in childhood; Edibe Pempeg l Yildiz, Sukran Poyrazoglu,Elsevier, Pediatric Neurology, 2015;
● Longitudinal Change of Vitamin D Status in Children With Epilepsy onAntiepileptic Drugs: Prevalence and Risk Factors; Yun-Jin Lee MD, PhDa,Kyung Mi Park MDa, Young Mi Kim MD, Department of Pediatrics, PusanNational University Children’s Hospital, Pusan National University School ofMedicine, Yangsan, Korea Department of Pediatrics, Pusan NationalUniversity Hospital, Busan Março 2017;
● Teagarden DL, Meador KJ, Loring DW. Low vitamin D levels are common inpatients with epilepsy. Epilepsy Res. 2014;108(8):1352-1356;
● Risk factors of vitamin D deficiency in children with epilepsy takinganticonvulsants at initial and during follow-up; Seung Ho Lee, MD and JeesukYu, MD, PhD Ann Pediatr Endocrinol Metab. 2015 Dec; 20(4): 198–205;
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