Clinical efficacy of levetiracetam on bone mineral density and bone metabolism in middle-aged and elderly patients with generalized tonic-clonic seizures

Abstract

To explore the effects of levetiracetam (LEV) on the changes of bone mineral density (BMD) and bone metabolism in the treatment of middle-aged and elderly patients with generalized tonic-clonic seizures. A total of 112 patients with generalized tonic-clonic seizures from October 2012 to March 2014 were selected and divided into LEV and non-medication groups according to therapeutic methods (n = 56 each). LEV was administered to LEV group at an initial dosage of 500 mg twice daily. The same dose of LEV could be added every 2 or 3 weeks based on clonic seizure condition and tolerance. And the maximal dosage was 2 000 mg. The therapeutic duration was ≥ 6 months. No anti-seizure drug was offered for non-medication group. Another 50 healthy subjects served as control group. After 6-month treatment the clinical efficacy of LEV group was evaluated. BMD was detected with bone sonometer (DPX-L) and serum levels of blood calcium (Ca), blood phosphorus (P), alkaline phosphatase and parathyroid hormone were also detected in control group, pre-treatment in non-medication group and post-treatment in LEV group. The rate of abnormal bone volume in non-medication (28.6%) and LEV groups (48.2%) were evidently higher than that in control group (4.0%) (P < 0.05). And it was apparently higher in LEV group than that in non-medication group (P < 0.05). BMD decreased obviously at post-treatment than pre-treatment (P < 0.05). And the post-treatment levels of Ca and P decreased markedly [(2.12 ± 0.19) vs (2.32 ± 0.23) mmol/L; (0.96 ± 0.01) vs (1.23 ± 0.12) mmol/L] while serum levels of alkaline phosphatase and parathyroid hormone increased significantly in LEV group than pre-treatment [(66 ± 6) vs (33 ± 3) µg/L; (62 ± 5) vs (34 ± 3) pmol/L, P < 0.05]. The clinical efficacy of LEV treatment at 1 month was similar to that at 6 months (both 98.21%). And the difference was insignificant (P > 0.05). Single use of LEV is efficacious in the treatment of middle-aged and elderly patients with generalized tonic-clonic seizures. However, both disease and anti-seizure drugs have certain effects on BMD. And long-term application of LEV may lead to bone metabolism dysfunction to some extent.