The Effect Of Topiramate To The Metabolism Of Children

Background and purposeEpilepsy is one of the common disease in children.The attack rate is about 0.3%～0.6%.long-term using antiepileptic drugs(AEDS)is the most general treatment to epilepsy.There are many adverse effects of AEDS.With the widespread use of the AEDS in the pediatrics,more and more pediatrian paid close attention to the relationship between AEDS and bone metabolism.A lot of internal and external researches have confirmed that it is dangerous to taking traditional AEDs for a long time for the growth of skeleton in children.Because the development of these diseases is slow and the clinical feature is various,only a few of people think highly of that.But biochemical indicators of bone metabolism change and bone density decreases in these disease.When the AEDs are used,we can monitor the indexes to discover the skeleton abnormality in time.Alkaline phosphatase(AKP)is the most frequently used biochemical indicator about osteogenesis,however,the AKP clinically metered in routine in serum comes from many organs,lacking of tissue specificity.At present,the best method is to measure Bone alkaline phosphatase(BAKP)in immunoradiometric assay.BAKP is secreted by osteoblast,is the specifical index in bone formation,excluding the effect of diseases in liver and gall.Bone is make up of bony mineral matter and bony matrix.Calcium and fosforus are the most important ingredients in bony mineral matter.Clinical doctors can know the condition of bone metabolism by detecting the mineral matters' content in blood or urine.The merit is non-traumatic,fast,sensitive and dynamic.In paediatrics,carbamazepine(CBZ),valproate(VPA)and topiramate(TPM) are in common use.TPM is a kind of weak carbonic anhydrase inhibitor.There are very few research about the relation to bone metabolism internal and external.But some researches have pointed out TPM could lead to metabolic acidosis.And a part of scholars found the AEDs could not always bring adverse effect about bone metabolism.This experiment is to analyze the effect of TPM to bone metabolism,using the change of specific indicators causing by taking TPM for a long time.MethodThis experiment chooses 40 children with epilepsy and 40 healthy children taking no drug as controls.Object:1.Without injury of liver,kidney and other special disease.2.In the near future,children with epilepsy utilizing no glucocorticoid or vitamin D in therapeutic dose.3.Children with epilepsy between 2 and 6 years old,taking drug for 3～6 months.Every child is taken 2 milliliter venous blood on an empty stomach,on 8-10 in the morning,to determine BAKP reflecting osteoplastic process.Meanwhile,to take rule laboratory examination to blood calcium and blood fosforus of the child taking TPM.Then analyze the data with SPSS 11.0 statistically,expressing indexes by mean,standard deviation and compareing in pairs by t test.ResultIndexes are blood calcium(TPM group 2.39±0.13mmol/L,no TPM group 2.36±0.12mmol/L),blood fosforus(TPM group 1.90±0.23mmol/L,no TPM group 1.86±0.15mmol/L),BAKP(TPM group 245.80±23.56mmol/L,no TPM group 219.63±14.69mmol/L).There is highly significant difference of BAKP between TPM group and no TPM group(P＜0.01),but no significant difference of blood calcium and blood fosforus(P＞0.05).ConclusionTPM can influence the bone formation,inducing the increase of BAKP. Children taking TPM need to be supplied with sufficient calcium and Vitamin D.If it is necessary,we should consider to detect HCO₃^- in blood an d bone density.