Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa

•The first sub-Saharan African study of vitamin D levels in children with epilepsy.•Children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels.•Children on enzyme-inducing ASM should be assessed for vitamin D deficiency. Purpose: The effects of antiseizure medications (ASMs) on b...

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Veröffentlicht in:Seizure (London, England) England), 2019-07, Vol.69, p.186-192
Hauptverfasser: Kija, Edward, Gidal, Barry E., Shapson-Coe, Alexander, Cader, Shihaam, van der Watt, George, Delport, Steve, Wilmshurst, Jo M
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container_start_page 186
container_title Seizure (London, England)
container_volume 69
creator Kija, Edward
Gidal, Barry E.
Shapson-Coe, Alexander
Cader, Shihaam
van der Watt, George
Delport, Steve
Wilmshurst, Jo M
description •The first sub-Saharan African study of vitamin D levels in children with epilepsy.•Children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels.•Children on enzyme-inducing ASM should be assessed for vitamin D deficiency. Purpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa. Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism. Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1–17 years) and controls 3 years (range 1–12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD2 (p = 0.0018), vitaminD3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products. Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.
doi_str_mv 10.1016/j.seizure.2019.04.020
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Purpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa. Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism. Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1–17 years) and controls 3 years (range 1–12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD2 (p = 0.0018), vitaminD3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products. Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels, probably as result of increased destruction of vitamin D. 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All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-b7e4b61c924d15d27c57b470c92ad3bdedad267d600e730c985f52a1fa9eccdf3</citedby><cites>FETCH-LOGICAL-c412t-b7e4b61c924d15d27c57b470c92ad3bdedad267d600e730c985f52a1fa9eccdf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.seizure.2019.04.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31075750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kija, Edward</creatorcontrib><creatorcontrib>Gidal, Barry E.</creatorcontrib><creatorcontrib>Shapson-Coe, Alexander</creatorcontrib><creatorcontrib>Cader, Shihaam</creatorcontrib><creatorcontrib>van der Watt, George</creatorcontrib><creatorcontrib>Delport, Steve</creatorcontrib><creatorcontrib>Wilmshurst, Jo M</creatorcontrib><title>Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa</title><title>Seizure (London, England)</title><addtitle>Seizure</addtitle><description>•The first sub-Saharan African study of vitamin D levels in children with epilepsy.•Children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels.•Children on enzyme-inducing ASM should be assessed for vitamin D deficiency. Purpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa. Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism. Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1–17 years) and controls 3 years (range 1–12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD2 (p = 0.0018), vitaminD3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products. Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.</description><subject>Adolescent</subject><subject>Africa</subject><subject>Anticonvulsants - adverse effects</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Antiseizure medications</subject><subject>Bone and Bones - drug effects</subject><subject>Bone and Bones - metabolism</subject><subject>Bone mineral metabolism</subject><subject>Bone Remodeling - drug effects</subject><subject>Bone Remodeling - physiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Cohort Studies</subject><subject>Cross-Sectional Studies</subject><subject>Diet</subject><subject>Epilepsy</subject><subject>Epilepsy - complications</subject><subject>Epilepsy - drug therapy</subject><subject>Epilepsy - epidemiology</subject><subject>Epilepsy - metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>South Africa - epidemiology</subject><subject>Vitamin D</subject><subject>Vitamin D - metabolism</subject><subject>Vitamin D Deficiency - complications</subject><subject>Vitamin D Deficiency - epidemiology</subject><subject>Vitamin D Deficiency - metabolism</subject><issn>1059-1311</issn><issn>1532-2688</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkM1u3CAUhVGVqEnTPkIrltnYuYAx41UVTX-lSFnkp0uE4VrDyDYO2KkmTx9GM-02K9DhO1z4CPnMoGTA6qttmdC_LBFLDqwpoSqBwztyzqTgBa9Xq5O8B9kUTDB2Rj6ktAWApmLiPTkTDJRUEs7J06OfzeBH-o2adgxxML2fPSZqRkfbMCKdlzjS8IwxR6bfJZ9oxu3G9y7iSP_6eUNx8j1Oabc_mTdI_2CaMdfWZkIaOnoXlkxdd9Fb85GcdqZP-Om4XpCHH9_v17-Km9ufv9fXN4WtGJ-LVmHV1sw2vHJMOq6sVG2lIAfGidahM47XytUAqESOV7KT3LDONGit68QFuTzcO8XwtOQH6cEni31vRgxL0pwLtqpq0aiMygNqY0gpYqen6AcTd5qB3tvWW320rfe2NVQ62869L8cRSzug-9_6pzcDXw8A5o8-e4w6WY-jRecj2lm74N8Y8Qpg65U3</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Kija, Edward</creator><creator>Gidal, Barry E.</creator><creator>Shapson-Coe, Alexander</creator><creator>Cader, Shihaam</creator><creator>van der Watt, George</creator><creator>Delport, Steve</creator><creator>Wilmshurst, Jo M</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201907</creationdate><title>Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa</title><author>Kija, Edward ; 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Purpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa. Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism. Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1–17 years) and controls 3 years (range 1–12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD2 (p = 0.0018), vitaminD3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products. Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31075750</pmid><doi>10.1016/j.seizure.2019.04.020</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; Access via ScienceDirect (Elsevier); Free E-Journal (出版社公開部分のみ)
subjects Adolescent
Africa
Anticonvulsants - adverse effects
Anticonvulsants - therapeutic use
Antiseizure medications
Bone and Bones - drug effects
Bone and Bones - metabolism
Bone mineral metabolism
Bone Remodeling - drug effects
Bone Remodeling - physiology
Child
Child, Preschool
Children
Cohort Studies
Cross-Sectional Studies
Diet
Epilepsy
Epilepsy - complications
Epilepsy - drug therapy
Epilepsy - epidemiology
Epilepsy - metabolism
Female
Humans
Infant
Male
South Africa - epidemiology
Vitamin D
Vitamin D - metabolism
Vitamin D Deficiency - complications
Vitamin D Deficiency - epidemiology
Vitamin D Deficiency - metabolism
title Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa
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