CC BY 4.0 · Journal of Child Science 2020; 10(01): e87-e92
DOI: 10.1055/s-0040-1715860
Original Article

Vitamin D Status of Epileptic Children in India: A Prospective Cross-Sectional Study from a Tertiary Care Centre

1   Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
,
Vishal Guglani
1   Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
,
Jasbinder Kaur
2   Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
,
1   Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
,
Sukhvinder Singh
3   Department of Medicine, H S Judge Institute of Dental Sciences, Punjab University, Chandigarh, India
,
Sumiti Banga
1   Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
› Institutsangaben
Funding This research project was funded by the Department of Science and Technology, Chandigarh, India.

Abstract

Vitamin D deficiency is prevalent all over the world, especially in tropical countries. In epileptics, antiepileptic drugs (AED) and associated comorbidities further impact vitamin D status. The aim of this study is to estimate the prevalence of 25(OH) vitamin D deficiency in epileptic children and evaluate probable risk factors. A cross-sectional study of 200 children between 1 and 18 years of age on AED was undertaken in the pediatric neurology clinic of a tertiary care center of Northern India. In all children, serum 25(OH) vitamin D levels, calcium, phosphorus, and alkaline phosphatase were estimated. The deficiency levels of vitamin D were categorized as: deficiency <20 ng/mL, insufficiency 20 to 30 ng/mL, and sufficiency >30 ng/mL. The potential risk factors for hypovitaminosis D, including type of epilepsy, AED regimen (specific medications, polytherapy vs. monotherapy), cerebral palsy, ambulatory status, intellectual disability, body mass index, gender, and vegetarianism were examined. Among the 200 enrolled children (60% boys), 106/200 (53%) were vitamin D deficient. There was no significant relation of vitamin D levels with gender, type of epilepsy, neurological deficit, and type of AED. An inverse relationship of higher phenytoin doses during monotherapy associated with lower vitamin D levels in monotherapy was found, thereby suggesting adverse effect of high doses of phenytoin on vitamin D levels. VDD is common among epileptic children on AED therapy. Vitamin D deficiency is common prevalent among epileptic children on AED therapy, and its detection and treatment correction should be an integral part of epilepsy management.



Publikationsverlauf

Eingereicht: 07. Februar 2020

Angenommen: 07. Juli 2020

Artikel online veröffentlicht:
02. September 2020

© .

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122 (02) 398-417
  • 2 Rovner AJ, O'Brien KO. Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Arch Pediatr Adolesc Med 2008; 162 (06) 513-519
  • 3 Marwaha RK, Tandon N, Reddy DRHK. , et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 2005; 82 (02) 477-482
  • 4 Pack AM, Morrell MJ, Randall A, McMahon DJ, Shane E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology 2008; 70 (18) 1586-1593
  • 5 Shellhaas RA, Barks AK, Joshi SM. Prevalence and risk factors for vitamin D insufficiency among children with epilepsy. Pediatr Neurol 2010; 42 (06) 422-426
  • 6 Farhat G, Yamout B, Mikati MA, Demirjian S, Sawaya R, El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002; 58 (09) 1348-1353
  • 7 Sheth RD, Binkley N, Hermann BP. Progressive bone deficit in epilepsy. Neurology 2008; 70 (03) 170-176
  • 8 Menon B, Harinarayan CV. The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism--a longitudinal study. Seizure 2010; 19 (03) 153-158
  • 9 Valsamis HA, Arora SK, Labban B, McFarlane SI. Antiepileptic drugs and bone metabolism. Nutr Metab (Lond) 2006; 3 (01) 36
  • 10 Scheffer IE, Berkovic S, Capovilla G. , et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsia 2017; 58 (04) 512-521
  • 11 Holick MF, Binkley NC, Bischoff-Ferrari HA. , et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (07) 1911-1930
  • 12 Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children (Basel) 2017; 4 (04) E30
  • 13 Khairnar MR, Wadgave U, Shimpi PV. Kuppuswamy's socio-economic status scale: a revision of occupation and income criteria for 2016. Indian J Pediatr 2017; 84 (01) 3-6
  • 14 Fong CY, Kong AN, Poh BK. , et al. Vitamin D deficiency and its risk factors in Malaysian children with epilepsy. Epilepsia 2016; 57 (08) 1271-1279
  • 15 Fong CY, Riney CJ. Vitamin D deficiency among children with epilepsy in South Queensland. J Child Neurol 2014; 29 (03) 368-373
  • 16 Lee Y-J, Park KM, Kim YM, Yeon GM, Nam SO. Longitudinal change of vitamin D status in children with epilepsy on antiepileptic drugs: prevalence and risk factors. Pediatr Neurol 2015; 52 (02) 153-159
  • 17 Sreedharan M, Devadathan K, Mohammed Kunju PA. , et al. Vitamin D deficiency in ambulant children on carbamazepine or sodium valproate monotherapy. Indian Pediatr 2018; 55 (04) 307-310
  • 18 Chaudhuri JR, Mridula KR, Rathnakishore C, Balaraju B, Bandaru VS. Association of 25-hydroxyvitamin D deficiency in pediatric epileptic patients. Iran J Child Neurol 2017; 11 (02) 48-56
  • 19 Toopchizadeh V, Barzegar M, Masoumi S, Jahanjoo F. Prevalence of vitamin D deficiency and associated risk factors in cerebral palsy a study in north-west of Iran. Iran J Child Neurol 2018; 12 (02) 25-32
  • 20 Vestergaard P. Effects of antiepileptic drugs on bone health and growth potential in children with epilepsy. Paediatr Drugs 2015; 17 (02) 141-150
  • 21 Harijan P, Khan A, Hussain N. Vitamin D deficiency in children with epilepsy: do we need to detect and treat it?. J Pediatr Neurosci 2013; 8 (01) 5-10
  • 22 Basu S, Gupta R, Mitra M, Ghosh A. Prevalence of vitamin d deficiency in a pediatric hospital of eastern India. Indian J Clin Biochem 2015; 30 (02) 167-173
  • 23 Mousavi SE, Amini H, Heydarpour P, Amini Chermahini F, Godderis L. Air pollution, environmental chemicals, and smoking may trigger vitamin D deficiency: evidence and potential mechanisms. Environ Int 2019; 122: 67-90