A study on anticonvulsant-induced rickets and treatment.
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概要
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Long-term aministration of anticonvulsant is thought to affect calcium and vitamin D metabolism, and to cause rickets or osteomalacia. It was the purpose of this study to elucidate the factors which lead the bones to rachitic cahnges, and to evaluate the effects of 1α-hydroxy vitamin D<SUB>3</SUB> (1α-OH-D<SUB>3</SUB>) on patients suffering from mild or moderate osteomalacia. The study was performed on 92 epileptic patients aged 3 to 22 years (mean 10.5) who had been receiving anticonvulsant drugs for 3 to 19 years (mean 5.8). The authers measured the serum concentrations of calcium (Ca), phosphorus (P), alkalinephosphatase (Al-p), 25-hydroxyvitamin D (25-OH-D), and evaluated ΣGS/D (index of bone density) by microdensitometry. 1α-OH-D<SUB>3</SUB> was given to the 16 patients of 92, whose serum concentrations of 25-OH-D or the values of ΣGS/D showed the lower levels than the normal ranges respectively.<BR>Results: 1) In 21 of the 92 patients, serum calcium levels were lower than the lower limit of normal values obtained in age-matched controls. In 17 of 92, serum 25-OH-D levels were lower than the lower limit of normal values (13.8 ug/m<I>l</I>), and in 8 of 17, the values of ΣGS/D were lower than -1.65 S. D. from the mean value. 2) In 11 of 82 patients, the values of ΣGS/D were lower than -1.65 S. D. from the mean value, and all of 11 had been received multiple anticonvulsants concurrently for more than 7 years. In 8 of 11, serum 25-OH-D levels were lower than the lower limit of normal values. 3) Mean serum Ca levels of the 16 patients whose 25-OH-D levels of ΣGS/D values were lower than normal ranges, showed significant increse from 9.0 to 9.3mg/d<I>l</I> by administrating 1α-OH-D<SUB>3</SUB> for 3 months. The mean serum 25-OH-D level significantly increased from 15.8 to 26.7ng/m<I>l</I> by treatment for 6 months.Increasing rate of ΣS/D values of patients taking 1α-OH-D3 for 18 months was more than that of age-dependent controls.<BR>It was concluded that long-term treatment with concurrent use of multiple drugs was the factor leading to rachitic changes, and that evaluation of ΣGS/D with serum Ca and 25-OH-D was useful for early detection of rachitic changes. Treatment with 1α-OH-D<SUB>3</SUB> improved the bone density in epileptic children receiving long-term anticonvulsant drugs.
- 一般社団法人 日本てんかん学会の論文
一般社団法人 日本てんかん学会 | 論文
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