Effect of antiseizure medications on calcium profile, thyroid profile and bone mineral density in children

Aim: This study was done to see the effect of anti-seizure medications (ASM) on calcium metabolism, thyroid profile and bone mineral density (BMD) in children with epilepsy.

Methodology:

This is a prospective cross-sectional study from April 2018 to December 2021. Cases were children who were on ASM for at least 1 year, controls were their healthy siblings. Both groups were studied for Serum calcium, phosphorus, alkaline phosphatase,T3, T4 and TSH and Dexa-Z score (AP spine and dual femur) Results: 78 cases and 48 controls were enrolled; who were comparable for age, gender, height, weight, BMI, sunlight exposure (>30 min) and physical activity (> 60 min). 61% of cases and 45 controls received Vitamin D. No significant difference noted between BMD of cases and controls, low Dexa- Z scores (-2) noted in 33% cases and 20% controls. Amongst cases, lower Dexa Z scores correlated with duration of ASM > 3 years. Type of drug and mono/polytherapy did not significantly affect the BMD. No difference was observed between cases and controls in calcium and thyroid profile, serum alkaline phosphate levels (> 400 U) were noted to be significantly higher in children who received ASM for more than 2 years.

Conclusions: High prevalence of low BMD was noted even amongst controls in our population. Amongst the cases, prolonged use of ASM is associated with lower BMD and higher serum alkaline phosphatase levels. Apart from Vit D supplementation; the role of physical activity and sunlight exposure as protective factors needs to be studied further.
Keywords: bone health, antiseizure medications, Densitometry, thyroid, calcium