Body mass index [BMI] and some hormonal changes in epileptic children receiving antiepileptic therapy

Epilepsy is a common neurological problem. It's treatment is often for years or even lifelong. The primary treatment of choice is the use of the antiepileptic drugs [AEDs]. Endocrine disorders are of major concern for clinicians who treat patients with epilepsy. This prospective hospital based study was conducted during the period from March 2008 till November 2010 at Assiut Children University Hospital. The aim of the study was to assess the effect of some antiepileptic drugs is Valproic acid, Carbmazepine or Topirmate, either monotherapy in combination on body weight and some endocrine aspects in epileptic children. The study included 62 epileptic children and 25 age and sex matched normal children as control. The cases were divided into 4 groups: [Group 1] included 22 cases on Valproic acid alone, [Group 2] included 19 cases on Valproic acid and Carbmazepine, [Group 3] included 21 cases on Valproic acid and Topirmate and control cases [Group 4]. All children were subjected to detailed medical history, full neurological examination, measurement of height, weight and body mass index [BMI], in addition to estimation of serum levels of leptin, insulin and fasting blood glucose levels. Patients treated with Valproic acid alone [group1] had significantly increased BMI and serum levels of leptin and insulin when compared with either [group3] or [group 4]. Cases on both Valproic acid and Carbmazepine [group 2] had significantly higher serum level of leptin, insulin and BMI when compared with control group [group 4].Cases on both Valproic acid and Topiramate had significantly higher serum level of insulin when compared with control group [group 4].Serum level of leptin in cases treated with Valproic acid had positive correlation with age, BMl,insulin, dose and treatment duration. Cases of obese parents had increased BMI, serum leptin and insulin when compared with cases of non obese parents. The study concluded that children receiving antiepileptic medications especially valoproic acid are at a great risk for development of obesity especially if associated with other risk factors as female sex and obese parents. Leptin and insulin serum levels should be checked regularly during treatment with antiepileptic drug therapy especially Valproic acid

Osteomalacia potentially induced among treated epileptic children

Anticonvulsants osteomalacia is a problem which is growing up with the wide use of different types of AEDs. We aimed to evaluate the effect of AEDs on calcium metabolism in epileptic children. This study included 40 well diagnosed epileptic children who were attending regularly neurology outpatient clinic. - Ain Shams University hospitals at a period from May 1995 to August 1996. They were receiving anti-epileptic drugs for more than 18 months either carbamazepin or valproic acid or both. Their ages ranged between 6 and 10 years [mean age 8.5 +/- 1.1 years]. Another 20 apparently healthy children in the same cohort were chosen to serve as control [mean age 8.1 +/- 1.5 years]. The results of this study showed that there was a highly significant decrease in weight and height percentiles [P< 0.001]. In addition, there was a highly significant decrease in mean calcium metabolism parameters [25 [OH] D3, calcium, and phosphorus] with increase in mean alkaline phosphatase [p < 0.001] among treated epileptic children compared to controls. This finding was strongly evident not only in monotherapy but also in polytherapy treated epileptics compared to controls. However, there was no statistical significant difference between monotherapy Vs polytherapy treated epileptic children. According to the duration of treatment, there was significant decrease in mean weight and height percentiles [p < 0.05] and a highly significant decrease in 25 [OH] D3 in epileptic children treated for a period more than 3years [p <0.001] but there was no statistical significant difference in other parameters of calcium metabolism [p > 0.05]. We could conclude that AEDs had a negative effect on weight and height percentiles in which are aggravated by longer duration of treatment and number of drugs used to control fits. This was accompanied by a state of biochemical osteomalacia in the form of decreased serum 25 [OH] D3, calcium, phosphorus and increased serum alkaline phosphatase. Lastly, regular check up of calcium metabolism parameters for early detection of their alteration is recommended and using monotherapy is advisable especially in growing children. Evaluation of the effect of new AEDs on calcium metabolism is essential