Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Department of Endocrinology and Diabetes, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
Calcif Tissue Int. 2021 Aug;109(2):139-146. doi: 10.1007/s00223-021-00842-3. Epub 2021 Apr 7.
This study aimed to investigate the prevalence of fractures and non-fracture injuries, including associated risk factors, in children with epilepsy prescribed antiseizure medications (ASM). A controlled, cross-sectional study was conducted in a hospital outpatient setting, comparing children with epilepsy prescribed ASMs with their non-epileptic siblings. Information was collected by questionnaire included history of fractures, non-fracture injuries and epilepsy, comorbidities and ASM use. 261 participants completed the questionnaire, 133 children with epilepsy (aged 10.7 ± 3.5 years, mean ± SD) and 128 siblings (10.1 ± 3.7 years). There were 49 non-seizure-related fractures in 34 ASM patients while prescribed ASMs, compared with 21 lifetime fractures in 15 controls, giving a 2.7 (95% CI 1.3-5.3, p = 0.007) times greater fracture prevalence in children treated with ASMs compared to healthy siblings. The rates of non-fracture injuries were similar across groups, except that concussion was more common in children taking ASMs (9.0% vs 1.6%, p = 0.026). Duration of ASM use and generalized tonic-clonic seizures (GTCS) were independent predictors of fractures (OR 1.55; 95% CI 1.03-2.31, p = 0.03; OR 2.50; 95% CI 1.05-5.94, p = 0.04, respectively). Fewer than 20% of participants and/or their families were aware that ASM use was related to bone health. Children with epilepsy treated with ASMs had a higher fracture prevalence than their sibling controls. Duration of ASM treatment and GTCS were associated with fracture risk. Longitudinal prospective studies are required to further explore risk and the direct impact of epilepsy on bone health.
本研究旨在调查服用抗癫痫药物（ASM）的癫痫患儿骨折和非骨折损伤的患病率，包括相关的危险因素。在医院门诊环境中进行了一项对照、横断面研究，比较了服用 ASM 的癫痫患儿与其非癫痫兄弟姐妹。通过问卷调查收集信息，包括骨折、非骨折损伤和癫痫病史、合并症和 ASM 使用情况。261 名参与者完成了问卷，其中 133 名癫痫患儿（年龄 10.7 ± 3.5 岁，均值 ± 标准差）和 128 名兄弟姐妹（10.1 ± 3.7 岁）。在服用 ASM 的 34 名患者中，有 49 例与癫痫无关的骨折，而在 15 名对照者中，有 21 例一生中发生过骨折，服用 ASM 的患儿骨折患病率是健康兄弟姐妹的 2.7 倍（95%CI 1.3-5.3，p=0.007）。两组的非骨折损伤发生率相似，但服用 ASM 的患儿中脑震荡更常见（9.0% vs 1.6%，p=0.026）。ASM 使用时间和强直阵挛性发作（GTCS）是骨折的独立预测因素（OR 1.55；95%CI 1.03-2.31，p=0.03；OR 2.50；95%CI 1.05-5.94，p=0.04）。不到 20%的参与者及其家属意识到 ASM 使用与骨骼健康有关。服用 ASM 的癫痫患儿骨折患病率高于其兄弟姐妹对照组。ASM 治疗时间和 GTCS 与骨折风险相关。需要进行前瞻性纵向研究以进一步探讨风险和癫痫对骨骼健康的直接影响。
