Abstract
BackgroundAnti-seizure medication (ASM) treatment is one of the significant risk factors associated with abnormal vitamin D status in epilepsy patients. Multiple studies have shown that adult epilepsy patients can exhibit vitamin D deficiency. However, there are few reports investigating pediatric epilepsy patients. In this study, we aimed to identify risk factors related to hypovitaminosis D in pediatric epilepsy patients in Thailand.MethodsA cross-sectional retrospective cohort study was conducted in 138 pediatric epilepsy patients who received anticonvulsants from April 2018 to January 2019. Demographic data, seizure types, puberty status, physical activity, duration, and types of anti-seizure medications were analyzed. Patients with abnormal liver function, abnormal renal function, and who received vitamin D supplements or ketogenic diet containing vitamin D were excluded. Levels of serum vitamin D (25(OH)D) were measured.ResultsAll 138 subjects were enrolled, the age ranged from 1.04 – 19.96 years; (mean = 9.65 ± 5.09), the mean serum 25(OH) D level was 26.56 ± 9.67 ng/ml. The prevalence of vitamin D deficiency was 23.2% and insufficiency was 47.8% respectively. Two risk factors—puberty status (OR 5.43, 95% CI 1.879-15.67) and non-enzyme-inhibiting ASMs therapy (OR 3.58, 95% CI 1.117-11.46)—were significantly associated with hypovitaminosis D, as shown by multivariate analyses.ConclusionsOur study reports the high prevalence of hypovitaminosis D in pediatric epilepsy patients in Thailand despite being located in the tropical zone. These findings can guide clinicians to measure vitamin D status in pediatric epilepsy patients particularly when they reach puberty and/or are using non-enzyme-inhibiting ASMs therapy. Early detection of vitamin D status and prompt vitamin D supplementation can prevent fractures and osteoporosis later in life.Trial registrationTCTR20210215005 (http://www.clinicaltrials.in.th/).
Highlights
Anti-seizure medication (ASM) treatment is one of the significant risk factors associated with abnormal vitamin D status in epilepsy patients
If developmental delay was suspected, patients under 6 years of age were assessed with Mullen Scales of Early Learning (MSEL), and the children older than 6 years of age were tested with the Wechsler Intelligence Scale for Children-Third Edition
Irrespective of age, had a serum 25(OH) D level less than 30 ng/ml, and lower levels were associated with a higher age
Summary
Anti-seizure medication (ASM) treatment is one of the significant risk factors associated with abnormal vitamin D status in epilepsy patients. We aimed to identify risk factors related to hypovitaminosis D in pediatric epilepsy patients in Thailand. Substrates in the skin are converted to vitamin D3 (cholecalciferol) Foods such as cod liver oil, milk fat, butter, animal liver, and egg yolk are another source of vitamin D, in the form of vitamin D 2 (ergocalciferol). Both vitamin D 3 and vitamin D2 are metabolized in the liver and converted by 25-hydroxylases into calcidiol (25[OH]D), a prehormone that is the major circulating form of vitamin D and is used to determine an individual’s vitamin status. Circulating 25(OH) D is eventually metabolized in the kidneys to a more biologically active form known as calcitriol (1,25(OH)2D), which serves various functions such as increasing calcium and phosphorus absorption in the intestines, inhibiting the secretion of parathyroid hormone, and modulating the formation and development of bones and teeth [4]
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