Ecevit Ciğdem, Aydoğan Aysel, Kavakli Tülay, Altinöz Serdar
Department of Pediatrics, Dr. Behçet Uz Children's Hopsital, 1374 Sokak no. 11, Alsancak, Izmir, Turkey.
Pediatr Neurol. 2004 Oct;31(4):279-82. doi: 10.1016/j.pediatrneurol.2004.03.021.
The objective of this study was to examine the effect of carbamazepine and valproate monotherapy on bone mineral density in children. Femoral neck area bone mineral density was measured by dual-energy x-ray absorptiometry in 31 healthy children and 33 children with idiopathic epilepsy treated with either carbamazepine (n = 17) or valproate (n = 16) for more than 6 months. There were no significant differences between the control and study patients in age, height, weight, and physical activity. No patient had dietary restrictions or neurologic impairment. Serum levels (as mean +/- S.D.) of valproate and carbamazepine were 53.75 +/- 23.94 microg/mL and 6.26 +/- 2.00 microg/mL, respectively, and the duration of treatment for each drug was 24.38 +/- 10.58 months and 31.76 +/- 16.33 months, respectively. Calcium intake in the diet was similar in both the control and study groups. In the valproate-treated group, 25% of the patients were hypocalcemic, 6% had elevated alkaline phosphatase levels, and 50% were hypophosphatemic. In the carbamazepine-treated group, 17.6% of the patients were hypocalcemic and 35.3% were hypophosphatemic. Children treated with valproate had 31.9% reduction in bone mineral density at the femoral neck area (P < 0.05); the 20% reduction in bone mineral density in this anatomic location in carbamazepine-treated children was not significant. In conclusion, valproate monotherapy, but not carbamazepine therapy, significantly reduces femoral neck area bone mineral density in children with idiopathic epilepsy.
本研究的目的是检测卡马西平和丙戊酸单一疗法对儿童骨矿物质密度的影响。采用双能X线吸收法测量了31名健康儿童以及33名接受卡马西平（n = 17）或丙戊酸（n = 16）治疗超过6个月的特发性癫痫儿童的股骨颈区域骨矿物质密度。对照组和研究组患者在年龄、身高、体重和身体活动方面无显著差异。所有患者均无饮食限制或神经功能损害。丙戊酸和卡马西平的血清水平（均值±标准差）分别为53.75±23.94μg/mL和6.26±2.00μg/mL，每种药物的治疗时长分别为24.38±10.58个月和31.76±16.33个月。对照组和研究组的饮食钙摄入量相似。在丙戊酸治疗组中，25%的患者血钙过低，6%的患者碱性磷酸酶水平升高，50%的患者血磷过低。在卡马西平治疗组中，17.6%的患者血钙过低，35.3%的患者血磷过低。接受丙戊酸治疗的儿童股骨颈区域骨矿物质密度降低了31.9%（P < 0.05）；卡马西平治疗的儿童在该解剖部位骨矿物质密度降低20%，差异不显著。总之，对于特发性癫痫儿童，丙戊酸单一疗法可显著降低股骨颈区域骨矿物质密度，而卡马西平疗法无此效果。
