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Curr Treat Options Neurol. 2011 Aug;13(4):346-54. doi: 10.1007/s11940-011-0133-x.
When treating a person with epilepsy, one must consider many factors in addition to the obvious need to treat the seizures. Both epilepsy itself and treatment with antiepileptic drugs (AEDs) subject one to numerous potential secondary long-term health concerns. Poor bone health is one of these concerns. Studies suggest that persons with epilepsy treated with AEDs have an increased risk of fracture, low bone mineral density (BMD), and abnormalities in bone metabolism. Multiple factors likely contribute to the increased risk. Falls during generalized tonic-clonic seizures, secondary effects of AEDs on balance, inactivity, low BMD, reduced calcium intake, reduced active vitamin D metabolites, and a genetic predisposition to low BMD may all contribute. Studies suggest a differential influence of AEDs. Phenytoin, phenobarbital, and primidone are most consistently associated with a negative impact on bone. Carbamazepine and valproate may also result in bone abnormalities, but data are mixed. Current studies suggest that lamotrigine has limited (if any) effect, but again, data are inconsistent. Other AEDs have received limited study. Screening for poor bone health includes serologic testing of vitamin D metabolites (notably 25-hydroxyvitamin D) as well as BMD testing using dual energy x-ray absorptiometry. Optimizing intake of calcium and vitamin D is important for all persons with epilepsy treated with AEDs. Although many treatments for low BMD are available, these agents have not been studied in persons with epilepsy treated with AEDs. Overall, physicians treating persons with epilepsy must consider the potential effect of having epilepsy and its main treatment, AED therapy, on bone health. For patients in whom bone health is a particular concern (eg, those with diagnosed bone disease or with significant risk factors for bone disease, including glucocorticosteroid use), it is best to avoid AEDs known to negatively affect bone. In addition, practitioners should work with other treating physicians to optimize bone health in these patients.
在治疗癫痫患者时，除了明显需要治疗癫痫发作外，还必须考虑许多因素。癫痫本身和抗癫痫药物（AEDs）的治疗都会引起许多潜在的长期健康问题。骨骼健康不良就是其中之一。研究表明，接受 AEDs 治疗的癫痫患者骨折、骨密度（BMD）降低和骨代谢异常的风险增加。多种因素可能导致风险增加。全身性强直阵挛发作期间的跌倒、AEDs 对平衡的继发性影响、不活动、低 BMD、钙摄入减少、活性维生素 D 代谢物减少以及低 BMD 的遗传易感性都可能起作用。研究表明 AEDs 的影响存在差异。苯妥英、苯巴比妥和扑米酮与对骨骼的负面影响最一致。卡马西平和丙戊酸也可能导致骨骼异常，但数据存在差异。目前的研究表明，拉莫三嗪的影响有限（如果有的话），但数据仍然不一致。其他 AEDs 的研究较少。骨骼健康不良的筛查包括维生素 D 代谢物（尤其是 25-羟维生素 D）的血清学检测以及双能 X 射线吸收法测定 BMD。优化钙和维生素 D 的摄入对所有接受 AEDs 治疗的癫痫患者都很重要。尽管有许多治疗低 BMD 的方法，但这些药物尚未在接受 AEDs 治疗的癫痫患者中进行研究。总体而言，治疗癫痫患者的医生必须考虑到癫痫及其主要治疗方法 AED 治疗对骨骼健康的潜在影响。对于骨骼健康特别关注的患者（例如，已诊断患有骨骼疾病或存在导致骨骼疾病的重大风险因素，包括使用糖皮质激素的患者），最好避免使用已知会对骨骼产生负面影响的 AEDs。此外，医生应与其他治疗医生合作，优化这些患者的骨骼健康。
