|
|
Vitamin D Deficiency and Epilepsy control in Women
Epilepsy medication affect vitamin D status
New research from the journal Epilepsy Research has found that vitamin D
deficiency affects epileptic patients differently depending on the
anti-epileptic drug they are taking.
Epilepsy is a neurological disorder that affects the activity of nerve cells in
your brain, causing epileptic seizures. The severity of seizures varies from
blankly staring for a few seconds to long periods of shaking. An epilepsy
diagnosis is made when someone experiences two or more seizures.
A common treatment for epilepsy is the use of antiepileptic drugs (AEDs). The
two main types are enzyme inducing drugs and non-enzyme inducing drugs. Enzyme
inducing AEDs increase the activity of certain enzymes and are known to put
patients at risk for osteoporosis by accelerating bone loss and decreasing bone
mineral density.
Since vitamin D plays a central role in bone health, researchers wanted to
examine the difference between the prevalence of vitamin D deficiency among
those who take enzyme inducing AEDs and those who take non-enzyme inducing AEDs.
In order to do this, researchers enrolled 596 patients with epilepsy into a
three year study. Some of the patients were taking enzyme inducing AEDs while
others were taking non-enzyme inducing AEDs.
The prevalence of vitamin D levels below 20 ng/ml among all patients, regardless
of their medication, was 45%. Vitamin D deficiency, as categorized by a level of
20 ng/ml or less, was present among 54% of the patients taking enzyme inducing
AEDs, versus 37% of patients taking non-enzyme inducing AEDs.
Based on their results, the researchers concluded, �Monitoring of vitamin D
should be considered as part of the routine management of patients with
epilepsy.�
Vitamin D deficiency linked to epilepsy
Epileptic seizures result from abnormal electrical activity in the brain. About
50 million people worldwide have epilepsy. Onset of new cases occurs most
frequently in infants and the elderly. About 3% of people will be diagnosed with
epilepsy at some time in their lives.
Congenital and developmental conditions are mostly associated with it among
younger patients; tumors are more likely over age 40; head trauma and central
nervous system infections may occur at any age. Up to 5% of people experience
seizures at some point in life.
New research shows almost half of all patients with epilepsy are vitamin D
deficient and suggests men are equally, if not more frequently, affected.
Presented here at the American Epilepsy Society 61st Annual Meeting, the study
showed 44.5% of epilepsy patients � 45.3% of men and 43.7% of women � were
vitamin D deficient, putting these patients at potential increased risk for a
wide variety of conditions, including osteoporosis, autoimmune disease, cancer,
cardiovascular disease, and infectious disease, among others.
"These results point out that vitamin D deficiency is very prevalent in the
seizure population and that men are equally or even more often affected than
women and therefore should not be overlooked or neglected," principal
investigator Ioannis Karakis, MD, from Boston University School of Medicine, in
Massachusetts, told Medscape Neurology & Neurosurgery.
The study's coinvestigator was Georgia Montouris, MD, also from Boston
University School of Medicine.
According to Dr. Karakis, it is well-known that vitamin D deficiency in the
general population is very common. In fact, he said, research by Michael F.
Hollick, MD, PhD, also from Boston University School of Medicine, who is widely
considered 1 of the top vitamin D researchers in the world, found that among a
healthy group of physicians and residents,
about one-third were vitamin D deficient (Tangpricha V et al. Am J Med.
2002;112:659-662).
More Risk Factors
According to Dr. Karakis, the investigators suspected vitamin D deficiency would
be even higher in epilepsy patients, in large part because antiepileptic
medications can affect vitamin D metabolism and lead to deficiency.
However, he said, patients with epilepsy often have other indirect risk factors
that can predispose them to vitamin D deficiency, many of which relate to
lifestyle changes due to their disease that limit sun exposure and physical
activity and consequently impair their bone-mineral density.
"Being less ambulatory affects bone-mineral density, and staying indoors limits
exposure to sunlight, which is a very important factor in vitamin D synthesis,"
said Dr. Karakis.
For the study, investigators measured 25-hydroxy-vitamin D levels in 285
ambulatory patients with a seizure disorder � 150 men and 135 women � attending
a single-center seizure clinic.
Overall they found 44.5% (127) subjects had vitamin D deficiency, which was
defined as serum levels of less than 20 ng/mL. When subjects were divided by
sex, the study showed 45.3% (68) of men and 43.7% (59) of women had
hypovitaminosis D.
All vitamin D deficient patients, said Dr. Karakis, were treated with 1 capsule
of 50,000 IU of vitamin D2 per week for 8 weeks, at which time levels were
rechecked. "Patients who were compliant experienced improvement," he said.
Men Deserve Equal Time
Dr. Karakis said it was somewhat surprising that vitamin D deficiency was more
prevalent in men and highlights the need for clinicians to aggressively assess
in this group of patients.
A subgroup analysis examined whether there was any difference in vitamin D
deficiency�prevalence rates associated with monotherapy with enzyme-inducing
antiepileptic drugs (EIAEDs) vs monotherapy with non�enzyme-inducing
antiepileptics (NEIAEDs).
Practically speaking, said Dr. Karakis, NEIAEDs comprise the newer antiseizure
medications, with the exception of valproate, an older AED that does not induce
the hepatic cytochrome P450 system. Among the enzyme inducers, most are older
agents, excluding oxcarbazepine, which is a partial enzyme inducer.
However, he said, with a prevalence rate of 46.2% and 34.2% for EIAEDs and
NEIAEDs respectively, the difference was not very striking.
"The first indications from this study show that although the impact of
non�enzyme-inducing antiepileptic medications on vitamin D levels is not as
great [as EIAEDs], they still have an impact on bone health," said Dr. Karakis.
Women with epilepsy advised to take vitamin D
The review was done by doctors at Leicester Royal Infirmary�s Department of
Paediatric Neurology. Their work shows that bone health in young people with
epilepsy may be a bigger problem than was previously thought. These young people
may be two or three times more likely to break bones than others their age.
Previous research has shown that epilepsy can affect bone health in some groups.
Some anti-epileptic medicines can affect bone metabolism. This is a process that
gradually replaces old bone tissue with new tissue � important in healing
fractures, for instance. The medicines can prevent the body doing this as
effectively as it should.
These medicines can also negatively affect bone density � so that a person�s
bones contain less minerals than they should. This makes them easier to break.
Previous research has shown increased risks of poor bone-health in older people
or menopausal women, for example. However, literature has suggested that young
people with epilepsy are not at increased risk of broken bones.
The review from Leicester Royal Infirmary disagrees. While the previous research
says that young people are not at a higher risk, the review points out that
these older studies only looked at very small numbers of people. They also
failed to take into account other factors that could affect bone health in
youngsters with epilepsy. These include things like other conditions, how mobile
the young person is, what their diet is like and whether they are obese.
The Leicester team say that further research in this area is urgently needed.
Still, they say that in the absence of reliable scientific evidence, young
people with epilepsy should be prescribed a low-dose vitamin D supplement. This
should lower the possible risk of fractures.
In the article was published in The Journal of Paediatric Neurosciences. In it,
authors state: �Low-dose vitamin D supplementation� is now recommended for
healthy children and it is biologically feasible that children with epilepsy may
be at higher risk of clinically significant deficiency. It is important that
neurologists ensure that low-dose vitamin D supplementation should be
prescribed� in children with epilepsy.�
Back
Dated 02 November 2015
|
|
|
|
|
|
|
