Puc-Campinas, Sao Paulo, Brazil.
Department of Neurology (SMPH), University of Wisconsin, Madison, USA.
Rev Neurol (Paris). 2023 Dec;179(10):1111-1117. doi: 10.1016/j.neurol.2023.04.007. Epub 2023 Sep 25.
To investigate vitamin D levels and factors associated with seizure control in adult patients with epilepsy (APE).
Cross-sectional study with APE in routine outpatient follow-up at a neurology clinic. Clinical variables, antiseizure medications (ASM) and vitamin D were investigated. Data were analyzed using the Chi or Fisher's exact tests, Mann-Whitney, Spearman's correlation coefficient, ROC curve and univariate and multiple logistic regression analysis.
Mean age was 46.5±15.1 years and disease duration was 27.5±17.0 years; 52.7% (n=49) of patients used one ASM and 47.3% (n=44) used≥2 ASM. There was a significant difference in the level of vitamin D according to the number of ASM and it was higher in patients who used a single ASM (26.02±10.22 versus 22.50±8.69; P=0.048). In the logistic regression, when vitamin D level was set at 20ng/mL, the chance of seizure control for patients using a single ASM was 6.99 times greater than for those using≥2 ASM. When vitamin D level was set at 40ng/mL, the number of ASM did not modify seizure control. There was no correlation between vitamin D and disease duration, patient age and age at the time of the first seizure. In the logistic regression, it was observed that satisfactory levels of vitamin D did not modify potential seizure control.
Thirty-three percent (33%) of patients presented with vitamin D deficiency (values below 20ng/mL) and 80% had vitamin D levels below what is recommended (30ng/mL). The use of ASM, when associated with different levels of vitamin D, modified the probability of seizure control in APE. Vitamin D levels and intrinsic epilepsy factors are associated with failure to effectively control seizures.
研究维生素 D 水平与癫痫（APE）成年患者癫痫发作控制相关的因素。
在神经病学诊所的常规门诊随访中，进行了一项 APE 的横断面研究。调查了临床变量、抗癫痫药物（ASM）和维生素 D。使用卡方或 Fisher 确切检验、Mann-Whitney、Spearman 相关系数、ROC 曲线以及单变量和多变量逻辑回归分析进行数据分析。
平均年龄为 46.5±15.1 岁，病程为 27.5±17.0 年；52.7%（n=49）的患者使用一种 ASM，47.3%（n=44）的患者使用≥2 种 ASM。根据 ASM 的数量，维生素 D 的水平存在显著差异，使用单一 ASM 的患者维生素 D 水平较高（26.02±10.22 与 22.50±8.69；P=0.048）。在逻辑回归中，当维生素 D 水平设定为 20ng/mL 时，使用单一 ASM 的患者癫痫发作控制的机会是使用≥2 种 ASM 的患者的 6.99 倍。当维生素 D 水平设定为 40ng/mL 时，ASM 的数量不会改变癫痫发作的控制。维生素 D 与疾病持续时间、患者年龄和首次癫痫发作时的年龄之间无相关性。在逻辑回归中，观察到维生素 D 水平的满意度并不能改变潜在的癫痫发作控制效果。
33%（33%）的患者存在维生素 D 缺乏（低于 20ng/mL），80%的患者维生素 D 水平低于推荐值（30ng/mL）。ASM 的使用与不同水平的维生素 D 相关，改变了 APE 患者癫痫发作控制的概率。维生素 D 水平和内在癫痫因素与未能有效控制癫痫发作有关。
