Shi Xiu-Yu, Ju Jun, Lu Qian, Hu Lin-Yan, Tian Ya-Ping, Guo Guang-Hong, Liu Zhi-Sheng, Wu Ge-Fei, Zhu Hong-Min, Zhang Yu-Qin, Li Dong, Gao Li, Yang Liu, Wang Chun-Yu, Liao Jian-Xiang, Wang Ji-Wen, Zhou Shui-Zhen, Wang Hua, Li Xiao-Jing, Gao Jing-Yun, Zhang Li, Shu Xiao-Mei, Li Dan, Li Yan, Chen Chun-Hong, Zhang Xiu-Ju, Zhong Jian-Min, Zhai Qiong-Xiang, Sun Yan-Hong, Lin Xue-Feng, Ren Rong-Na, Yin Fei, Chen Yan-Hui, Jia Fei-Yong, Yang Zhi-Xian, Wang Ju-Li, Xia Zhe-Zhi, Wang Li-Wen, Luo Rong, Zou Li-Ping
Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Pediatrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Epilepsia. 2023 Oct;64(10):2667-2678. doi: 10.1111/epi.17733. Epub 2023 Aug 14.
Bone metabolism can be influenced by a range of factors. We selected children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and lifestyles similar to those of healthy children to control for the confounding factors that may influence bone metabolism. We aimed to identify the specific effects of epilepsy and/or anti-seizure medications (ASMs) on bone metabolism.
Patients with SeLECTS were divided into an untreated group and a monotherapy group, and the third group was a healthy control group. We determined the levels of various biochemical markers of bone metabolism, including procollagen type I nitrogenous propeptide (PINP), alkaline phosphatase (ALP), osteocalcin (OC), collagen type I cross-linked C-telopeptide (CTX), calcium, magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D (VD ).
A total of 1487 patients (from 19 centers) were diagnosed with SeLECTS; 1032 were analyzed, including 117 patients who did not receive any ASMs (untreated group), 643 patients who received only one ASM (monotherapy group), and 272 children in the healthy control group. Except for VD , other bone metabolism of the three groups were different (p < .001). Bone metabolism was significantly lower in the untreated group than the healthy control group (p < .05). There were significant differences between the monotherapy and healthy control group in the level of many markers. However, when comparing the monotherapy and untreated groups, the results were different; oxcarbazepine, levetiracetam, and topiramate had no significant effect on bone metabolism. Phosphorus and magnesium were significantly lower in the valproic acid group than the untreated group (adjusted p < .05, Cliff's delta .282-.768). CTX was significantly higher in the lamotrigine group than in the untreated group (adjusted p = .012, Cliff's delta = .316).
Epilepsy can affect many aspects of bone metabolism. After controlling epilepsy and other confounders that affect bone metabolism, we found that the effects of ASMs on bone metabolism differed. Oxcarbazepine, levetiracetam, and topiramate did not affect bone metabolism, and lamotrigine corrected some of the abnormal markers of bone metabolism in patients with epilepsy.
骨代谢会受到一系列因素的影响。我们选择了具有中央颞区棘波的自限性癫痫患儿（SeLECTS）以及生活方式与健康儿童相似的患儿，以控制可能影响骨代谢的混杂因素。我们旨在确定癫痫和/或抗癫痫药物（ASMs）对骨代谢的具体影响。
将SeLECTS患者分为未治疗组和单药治疗组，第三组为健康对照组。我们测定了多种骨代谢生化标志物的水平，包括I型前胶原氨基端前肽（PINP）、碱性磷酸酶（ALP）、骨钙素（OC）、I型胶原交联C末端肽（CTX）、钙、镁、磷、甲状旁腺激素（PTH）和维生素D（VD）。
共有1487例患者（来自19个中心）被诊断为SeLECTS；对1032例进行了分析，包括117例未接受任何ASMs的患者（未治疗组）、643例仅接受一种ASMs的患者（单药治疗组）以及272名健康对照组儿童。除VD外，三组的其他骨代谢指标均存在差异（p <.001）。未治疗组的骨代谢明显低于健康对照组（p <.05）。单药治疗组与健康对照组在许多标志物水平上存在显著差异。然而，在比较单药治疗组和未治疗组时，结果有所不同；奥卡西平、左乙拉西坦和托吡酯对骨代谢无显著影响。丙戊酸组的磷和镁水平明显低于未治疗组（校正p <.05，Cliff's δ为0.282 - 0.768）。拉莫三嗪组的CTX水平明显高于未治疗组（校正p = 0.012，Cliff's δ = 0.316）。
癫痫会影响骨代谢的多个方面。在控制癫痫和其他影响骨代谢的混杂因素后，我们发现ASMs对骨代谢的影响有所不同。奥卡西平、左乙拉西坦和托吡酯不影响骨代谢，而拉莫三嗪纠正了癫痫患者的一些骨代谢异常标志物。
