Saturday, 3 January 2015

Anti-epileptic meds and pediatric serum vitamin D levels

No, I am not becoming obsessed with the sunshine vitamin/hormone despite us being only a few days into 2015 and this being my second post on vitamin D. It's just the way that the research posts fall; although regular readers will probably have noticed I do enjoy reading the various research on all-things vitamin D.
There has been an awakening...

The research fodder for today's post is the paper by Yun-Jin Lee and colleagues [1] who measured 25-hydroxy vitamin D levels (in serum) for quite a large participant group (N=143) of children "with epilepsy taking antiepileptic drugs" to ascertain what (if anything) happened to vitamin D levels as a consequence of said pharmacotherapy. Importantly, participants were medication-naïve at baseline (start of the trial) and followed up "at 6- to 12-month intervals".

Their results were interesting. "At the start of antiepileptic drugs and the last follow-up, vitamin D deficiency or insufficiency was recognized in 56.6% (81 of 143) and 79.0% (113 of 143), respectively." Deficiency and insufficiency by the way, were defined as <20 ng/mL (less than 20 ng/mL) and "between 21 and 29 ng/mL" respectively. When looking at the group as a whole, the authors reported that the average value of baseline serum vitamin D was 31.1 ± 14.7 ng/mL. This dropped to 20.2 ± 14.9 ng/mL at follow-up after the introduction of antiepileptic medication. Various factors might have influenced such a decrease including the use of more than one medication, a longer duration of medication use and being heavier in terms of weight. Age and type of antiepileptic did not however seem to play any significant role in the obtained results.

I should, at this point, draw attention to my primary caveat on this blog about not giving anything that looks, sounds or smells like medical or clinical advice. As per my other discussions on epilepsy and/or seizure-type disorders and their medication(s), please do not go altering medication patterns designed to control conditions which can be life-threatening without your healthcare professional being involved. Don't mess with epilepsy.

Onwards. This is not the first time that epilepsy and antiepileptic medication have been discussed in the peer-reviewed literature with vitamin D in mind. The paper by Mintzer and colleagues [2] (open-access) for example, discussed how consumers of carbamazepine or oxcarbazepine presented with significantly lower serum 25-hydroxyvitamin D (25-OHD) levels than asymptomatic controls. They concluded by suggesting that it may be "prudent" for such a patient group to receive vitamin D supplements alongside their medication. Indeed, if the paper by Holló and colleagues [3] is anything to go by, such supplementation might also be monitored for some potentially important positive effects too, although I hasten to add that I'm not suggesting that vitamin D is a cure-all for epilepsy.

Just before I go, I'd like to bring in some autism discussion into this post and what the Lee and other findings might mean for cases of autism and epilepsy combined. Acknowledging that epilepsy and/or seizure-type disorders are not an uncommon phenomena when a diagnosis of autism is received (see here), one might entertain the thought that issues with vitamin D present in cases of medication treated epilepsy might similarly overlay with autism + epilepsy in mind too. I've talked about vitamin D and autism a few times on this blog (see here and see here) and how, although not universally so [4], research into vitamin D deficiency and autism is in the ascendancy. Given the numbers of people with autism potentially in receipt of antiepileptic medication - suggested to be around 10% according to the paper by Aman and colleagues [5] in 2003 - one might be inclined to take such medication history into account when looking at issues with vitamin D in the context of [some] autism. Bone health as another potentially related factor [6] may be something else to consider in light of similar issues also potentially being present in cases of autism...

Music then: Los Lobos - Flor de Huevo.

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[1] Lee YJ. et al. Longitudinal Change of Vitamin D Status in Children With Epilepsy on Antiepileptic Drugs: Prevalence and Risk Factors. Pediatr Neurol. 2014 Oct 16. pii: S0887-8994(14)00606-7.

[2] Mintzer S. et al. Vitamin D levels and bone turnover in epilepsy patients taking carbamazepine or oxcarbazepine. Epilepsia. 2006 Mar;47(3):510-5.

[3] Holló A. et al. Correction of vitamin D deficiency improves seizure control in epilepsy: a pilot study. Epilepsy Behav. 2012 May;24(1):131-3.

[4] Uğur Ç. & Gürkan C. Serum vitamin D and folate levels in children with autism spectrum disorders. Research in Autism Spectrum Disorders. 2014; 8: 1641-1647.

[5] Aman MG. et al. Prevalence and patterns of use of psychoactive medicines among individuals with autism in the Autism Society of Ohio. J Autism Dev Disord. 2003 Oct;33(5):527-34.

[6] Nettekoven S. et al. Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy. Eur J Pediatr. 2008 Dec;167(12):1369-77.

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ResearchBlogging.org Lee YJ, Park KM, Kim YM, Yeon GM, & Nam SO (2014). Longitudinal Change of Vitamin D Status in Children With Epilepsy on Antiepileptic Drugs: Prevalence and Risk Factors. Pediatric neurology PMID: 25492388