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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