Hasaneen Bothina, Elsayed Riad Moustafa, Salem Nanees, Elsharkawy Ashraf, Tharwat Noha, Fathy Khaled, El-Hawary Amany, Aboelenin Hadil M
Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt.
Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt.
J Pediatr Neurosci. 2017 Apr-Jun;12(2):138-143. doi: 10.4103/jpn.JPN_161_16.
The aim of this study is to assess bone mineral status in children with epilepsy, on different antiepileptic drugs (AEDs) regimen, using dual-energy X-ray absorptiometry (DXA) and routine biochemical bone markers.
This is observational prospective controlled cohort study, conducted at Mansoura University Children Hospital, from January 2014 to June 2015. In this study, we had 152 participants with ages 3-13 years, 70 children diagnosed with epilepsy and 82 were controls. Children classified into two groups according to the duration of treatment, Group 1 children maintained on AEDs for 6-24 months, Group 2 children ≥24 months. Bone mineral density (BMD) measured by DXA and biochemical markers includes serum calcium, phosphorus, alkaline phosphatase (ALP), and parathyroid hormone (PTH).
In this study, we found that the serum level of calcium and phosphate were significantly low ( > 0.05) in total cases versus control. We found that the serum level of and ALP and PTH were significantly high ( > 0.05) in total cases versus control. Regarding the DXA markers, there was a significant decrease of BMD and Z-score for the total body and lumbar area in the total cases versus control ( > 0.05).
The present study showed that all AEDs (new and old) affect bone mineral status in children receiving therapy for more than 6 months, altering both biochemical markers (serum calcium, phosphorus, ALP, and PTH) and radiologic markers (BMD assessed using DXA). Children on AEDs for a longer duration (≥2 years) showed more severe side effects on BMD. Children receiving multiple AEDs are more prone to altered bone mineral status, especially with long duration of therapy. The study also highlights the role of DXA as a safe noninvasive method to assess BMD in children on long-term AEDs.
本研究旨在使用双能X线吸收法（DXA）和常规生化骨标志物，评估接受不同抗癫痫药物（AEDs）治疗方案的癫痫患儿的骨矿物质状况。
这是一项于2014年1月至2015年6月在曼苏拉大学儿童医院进行的观察性前瞻性对照队列研究。本研究中有152名年龄在3至13岁的参与者，70名被诊断为癫痫的儿童，82名作为对照。根据治疗持续时间将儿童分为两组，第1组儿童接受AEDs治疗6至24个月，第2组儿童接受治疗≥24个月。通过DXA测量骨矿物质密度（BMD），生化标志物包括血清钙、磷、碱性磷酸酶（ALP）和甲状旁腺激素（PTH）。
在本研究中，我们发现与对照组相比，所有病例的血清钙和磷水平显著降低（>0.05）。我们发现与对照组相比，所有病例的血清ALP和PTH水平显著升高（>0.05）。关于DXA标志物，与对照组相比，所有病例的全身和腰椎区域的BMD和Z评分显著降低（>0.05）。
本研究表明，所有AEDs（新药和旧药）均会影响接受治疗超过6个月的儿童的骨矿物质状况，改变生化标志物（血清钙、磷、ALP和PTH）和放射学标志物（使用DXA评估的BMD）。接受AEDs治疗时间较长（≥2年）的儿童对BMD的副作用更严重。接受多种AEDs治疗的儿童更容易出现骨矿物质状况改变，尤其是治疗时间较长时。该研究还强调了DXA作为评估长期使用AEDs儿童BMD的安全无创方法的作用。
