Factors Affecting Serum Vitamin D Level in Epilepsy

Year 2023, Volume: 50 Issue: 2 - Cilt 50, Sayı 2, 156 - 164, 12.06.2023

Pınar Bengi Boz

https://doi.org/10.5798/dicletip.1313185

Abstract

Objective: Our aim was evaluate the relationship between 25-Hydroxyvitamin D (25(OH)D) and old and new generation anti-seizure drugs (ASDs), seizure type and seizure frequency in epilepsy patients.
Method: A total of 96 individuals aged 18 years and older with epilepsy were included in this study who were followed up in the SBU Adana City Training and Research Hospital Epilepsy outpatient clinic between January 1, 2020 and November 1, 2022 and met the inclusion criteria. Patients were grouped by age, gender, seizure type, frequency, and ASDs usage (according to their relationship with cytochrome P450 enzymes). Complete blood count, kidney functions, serum ASD levels and calcium, magnesium, phosphate and parathormone levels, season when 25(OH)D were measured, and sun exposure time was also obtained from patient file scans.
Results: 55.2% of the patients were women and the mean age was 32.56±12.90 (Min:18 Max:71). 25(OH)D level was found to be deficient or insufficient in 95.8% of the patients. The 25(OH)D level was statistically significantly lower in patients with generalized and complex partial epilepsy who were exposed to the sun for less than one hour per week compared to the focal type and those exposed to the sun for more than one hour per week. p<0.05)
Conclusion: 25(OH)D levels should be closely monitored in patients with epilepsy who use ASD for a long time it should be aimed to provide effective seizure control and a positive effect on bone metabolism with appropriate replacement therapy.

Keywords

Epilepsy, seizure, anti-seizure medication, vitamin 25(OH)D

References

• 1.Bertoldo F, Cianferotti L, Di Monaco M, et al.Definition, Assessment, and Management of VitaminD Inadequacy: Suggestions, Recommendations, andWarnings from the Italian Society for Osteoporosis,Mineral Metabolism and Bone Diseases (SIOMMMS). Nutrients. 2022; 14(19): 4148. doi:10.3390/nu14194148
• 2.Zelzer S, Meinitzer A, Herrmann M, Goessler W,Enko D. A Novel Method for the Determination ofVitamin D Metabolites Assessed at the Blood-Cerebrospinal Fluid Barrier. Biomolecules. 2021;11(9): 1288. doi:10.3390/biom11091288
• 3.Tuckey RC, Cheng CYS, Slominski AT. The serumvitamin D metabolome: What we know and what isstill to discover. J Steroid Biochem Mol Biol. 2019;186: 4-21. doi:10.1016/j.jsbmb.2018.09.003
• 4.Vanherwegen AS, Gysemans C, Mathieu C.Regulation of Immune Function by Vitamin D and Its Use in Diseases of Immunity. Endocrinol Metab ClinNorth Am. 2017; 46(4): 1061-94.doi:10.1016/j.ecl.2017.07.010
• 5. Gil Á, Plaza-Diaz J, Mesa MD. Vitamin D: Classic and Novel Actions. Ann Nutr Metab. 2018; 72(2): 87-95.doi:10.1159/000486536
• 6.Holló A, Clemens Z, Kamondi A, Lakatos P, Szűcs A. Correction of vitamin D deficiency improves seizurecontrol in epilepsy: a pilot study. Epilepsy Behav.2012; 24(1): 131-3.doi:10.1016/j.yebeh.2012.03.011
• 7.Teagarden DL, Meador KJ, Loring DW. Lowvitamin D levels are common in patients withepilepsy. Epilepsy research. 2014; 108(8): 1352-6.
• 8.McNamara NA, Romanowski EMF, Olson DP,Shellhaas RA. Bone Health and EndocrineComorbidities in Pediatric Epilepsy. Semin PediatrNeurol. 2017; 24(4): 301-9.doi:10.1016/j.spen.2017.10.005
• 9.AK Türkyılmaz, EE Kurt, G Devrimsel. The effect ofserum vitamin D level and bone mineral density onbalance and the risk of falling in postmenopausalwomen. Diclemedj. 2013; 40(3): 391-5.doi:10.5798/diclemedj.0921.2013.03.0295
• 10.Feng Y, Cheng G, Wang H, Chen B. Theassociations between serum 25-hydroxyvitamin Dlevel and the risk of total fracture and hip fracture.Osteoporos Int. 2017; 28(5): 1641-52.doi:10.1007/s00198-017-3955-x
• 11.Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition ofepilepsy. Epilepsia. 2014; 55(4): 475-82.doi:10.1111/epi.12550
• 12.Tabachnick BG, Fidell LS. Experimental DesignsUsing ANOVA. Vol 724. Thomson/Brooks/ColeBelmont, CA; 2007.
• 13.Lips P, Cashman KD, Lamberg-Allardt C, et al.Current vitamin D status in European and MiddleEast countries and strategies to prevent vitamin Ddeficiency: a position statement of the EuropeanCalcified Tissue Society. Eur J Endocrinol. 2019;180(4): P23-P54. doi:10.1530/EJE-18-0736
• 14.Cunha IA, Saraiva AM, Lopes P, et al. Vitamin Ddeficiency in a Portuguese epilepsy cohort: who is at risk and how to treat. Epileptic Disord. 2021; 23(2):291-8. doi:10.1684/epd.2021.1268
• 15.Siniscalchi A, Murphy S, Cione E, Piro L, Sarro GD,Gallelli L. Antiepileptic Drugs and Bone Health:Current Concepts. Psychopharmacol Bull. 2020;50(2): 36-44. Accessed November 19, 2022.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255839/
• 16.Suljic EM, Mehicevic A, Mahmutbegovic N. Effectof Long-term Carbamazepine Therapy on BoneHealth. Med Arch. 2018; 72(4): 262-6.doi:10.5455/medarh.2018.72.262-6,
• 17.Sreedharan M, Devadathan K, Mohammed KunjuPA, et al. Vitamin D Deficiency in Ambulant Childrenon Carbamazepine or Sodium ValproateMonotherapy. Indian Pediatr. 2018; 55(4): 307-10.
• 18.Menninga N, Koukounas Y, Margolis A, BreslowR, Gidal B. Effects of enzyme-inducing antiseizuremedication on vitamin D dosing in adult veterans with epilepsy. Epilepsy Res. 2020; 161: 106287. doi:10.1016/j.eplepsyres.2020.106287
• 19.Aksoy D, Güveli BT, Ak PD, et al. Effects ofOxcarbazepine and Levetiracetam on Calcium,Ionized Calcium, and 25-OH Vitamin-D3 Levels inPatients with Epilepsy. Clin PsychopharmacolNeurosci. 2016; 14(1): 74-8.doi:10.9758/cpn.2016.14.1.74
• 20.Wang W, Gao Y, Zheng W, Li M, Zheng X.Phenobarbital inhibits osteoclast differentiation and function through NF-κB and MAPKs signalingpathway. Int Immunopharmacol. 2019; 69: 118-25.doi:10.1016/j.intimp.2019.01.033
• 21.Koo DL, Joo EY, Kim D, Hong SB. Effects oflevetiracetam as a monotherapy on bone mineraldensity and biochemical markers of bonemetabolism in patients with epilepsy. Epilepsy Res.2013; 104(1-2): 134-9.doi:10.1016/j.eplepsyres.2012.09.002
• 22.Artemiadis AK, Lambrinoudaki I, Voskou P, et al.Preliminary evidence for gender effects oflevetiracetam monotherapy duration on bone health of patients with epilepsy. Epilepsy Behav. 2016; 55:84-6. doi:10.1016/j.yebeh.2015.12.025
• 23.Albaghdadi O, Alhalabi MS, Alourfi Z, Youssef LA.Bone health and vitamin D status in young epilepsypatients on valproate monotherapy. Clin NeurolNeurosurg. 2016; 146: 52-6.doi:10.1016/j.clineuro.2016.04.019
• 24.Rahimdel A, Dehghan A, Moghadam MA,Ardekani AM. Relationship between Bone Densityand Biochemical Markers of Bone among TwoGroups Taking Carbamazepine and SodiumValproate for Epilepsy in Comparison with HealthyIndividuals in Yazd. Electron Physician. 2016; 8(11): 3257-65. doi:10.19082/3257
• 25.Yildiz EP, Poyrazoglu Ş, Bektas G, Kardelen AD,Aydinli N. Potential risk factors for vitamin D levelsin medium- and long-term use of antiepileptic drugsin childhood. Acta Neurol Belg. 2017; 117(2): 447-53.doi:10.1007/s13760-017-0775-x
• 26.Osteoproz ve metabolik kemik hastalıkları tanıve tedavi klavuzu. tjem. Published online 2016.doi:10.4274/tjem.omkhttk
• 27.Snoeijen-Schouwenaars FM, van Deursen KC,Tan IY, Verschuure P, Majoie MH. Vitamin Dsupplementation in children with epilepsy andintellectual disability. Pediatr Neurol. 2015; 52(2):160-4. doi:10.1016/j.pediatrneurol.2014.10.001