Bone Mineral Density in Epileptic Children Getting Long Term Anti-epileptic Drugs

Abstract

Background: Epilepsy is a common chronic neurological disorder with more than half of cases beginning in childhood. Most patients require long-term, and sometimes life-long, therapy with antiepileptic drugs (AEDs). AEDs are associated with significant side effects including radiological evidence of rickets, decreased bone mineral density (BMD), altered bone turnover, and increased risk of fracture. Aim of the Study: To assess the bone mineral density in epileptic children getting long term anti-epileptic drugs. Materials and Methods: This study was conducted in the Saleh Child Development and Disability Management Center (SCDDMC), of the Institute of Child and Mother Health (ICMH) Matuail, Dhaka. A total of 31 childrens age ranged 5-15 years diagnosed as epilepsy on the basis of both clinical examination and investigation (EEG) receiving antiepileptic drugs (AEDS) for at least two years were recruited in this study. Results: Almost two third (61.3%) children age group were in 5 to 10 years and 12(38.7%) in 10 to 15 years. Around three fourth (74.2%) children were male and 8(25.8%) were female. More than two third (67.7%) children had adequate sun exposure and more than three fourth (77.4%) children got adequate calcium and vit.D rich food. Majority (83.9%) of the patients got phenobarbitone (PB) followed by 17(54.8%) got combination, 13(41.9%) got valproic acid (VPA), 11(35.5%) got Nitrazipum (NTZ). More than one third (38.7%) children got mono therapy, 19(61.3%) got polytherapy. Majority of the children (96.8%) had serum calcium normal. The mean serum calcium was 9.22±0.78 mg/dl. The mean BMD of spine was 0.66±0.14. The mean BMD of neck left femur was 0.66±0.15. The mean BMD of neck right femur 0.66±0.15. More than two third (67.7%) children had low (<-1SD) BMD Z score. Almost two third (60.0%) children had mono therapy showed BMD Z score normal (>-1SD) and 6(28.6%) had BMD Z score low (<-1SD).  Almost three fourth (71.4%) children got poly therapy showed low BMD and 4(20.0%) got poly therapy showed normal BMD Z score. No significant association was found between BMD score and type and duration of therapy. Conclusion: AEDs decreased bone mineral density due to long term use as mono-therapy or polytherapy. The assessment of BMD among children with epilepsy receiving long term AEDs is essential.