Vestergaard Peter
Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark,
Paediatr Drugs. 2015 Apr;17(2):141-50. doi: 10.1007/s40272-014-0115-z.
Bone health may be impaired in children with epilepsy.
Our objective was to characterize bone mineral density (BMD) and bone growth in children receiving antiepileptic drugs (AEDs) and to assess the effects of co-morbidity, vitamin D deficiency, and type of drugs used.
Data were sourced from PubMed, Embase, and Web of Science.
Cross-sectional, cohort, case-control, or randomized controlled trials reporting BMD or parameters of bone growth.
Children with epilepsy compared with controls.
AEDS or ketogenic diet.
The studies were evaluated by one author.
Studies were categorized as reporting reduced BMD or not at any skeletal site as outcome. A logistic regression was performed for age, percent boys, study design, type of AED, co-morbidity or not, and signs of vitamin D deficiency/osteomalacia or not.
Carbamazepine and valproate were analyzed as monotherapy in 11 studies, and for both drugs a limited decrease in BMD seemed present. For oxcarbazepine, levetiracetam, phenytoin, phenobarbital, and topiramate, only one study with monotherapy was found for each drug, none of which reported decreased bone density. Polytherapy with AEDs seemed to be associated with a larger decrease in bone density than was monotherapy. Although few studies were available on bone growth, these did indicate that bone growth may be impaired among users of AEDs. Ketogenic diet may be associated with decreased bone density. The main determinant of normal BMD was absence of vitamin D deficiency/osteomalacia.
The studies differed in skeletal sites studied and most were cross-sectional. No head-to-head comparisons of AEDs were performed. Children treated with polytherapy or ketogenic diet may have more complicated and severe disease than those treated with monotherapy. The underlying cause of epilepsy and vitamin D deficiency may contribute to impaired bone growth and density.
Reduced bone density, impaired bone growth, and vitamin D deficiency may be seen in children treated with drugs against epilepsy.
Measures to correct vitamin D deficiency, calcium intake should be taken.
癫痫患儿的骨骼健康可能受损。
我们的目的是描述接受抗癫痫药物（AEDs）治疗的儿童的骨矿物质密度（BMD）和骨骼生长情况，并评估合并症、维生素D缺乏和所用药物类型的影响。
数据来自PubMed、Embase和科学网。
报告BMD或骨骼生长参数的横断面研究、队列研究、病例对照研究或随机对照试验。
癫痫患儿与对照组。
AEDs或生酮饮食。
由一位作者对研究进行评估。
将研究分类为报告任何骨骼部位BMD降低或未降低的结果。对年龄、男孩百分比、研究设计、AED类型、是否合并症以及是否有维生素D缺乏/骨软化症迹象进行逻辑回归分析。
在11项研究中，卡马西平和丙戊酸作为单一疗法进行了分析，两种药物的BMD似乎都有有限程度的降低。对于奥卡西平、左乙拉西坦、苯妥英、苯巴比妥和托吡酯，每种药物仅找到一项单一疗法的研究，均未报告骨密度降低。与单一疗法相比，AEDs联合治疗似乎与更大程度的骨密度降低有关。虽然关于骨骼生长的研究较少，但这些研究确实表明AEDs使用者的骨骼生长可能受损。生酮饮食可能与骨密度降低有关。正常BMD的主要决定因素是不存在维生素D缺乏/骨软化症。
各研究在研究骨骼部位方面存在差异，且大多数为横断面研究。未对AEDs进行直接比较。接受联合治疗或生酮饮食治疗的儿童可能比接受单一疗法治疗的儿童病情更复杂、更严重。癫痫和维生素D缺乏的潜在原因可能导致骨骼生长和密度受损。
接受抗癫痫药物治疗的儿童可能出现骨密度降低、骨骼生长受损和维生素D缺乏。
应采取措施纠正维生素D缺乏，增加钙的摄入量。
