| Background:Epilepsy is a common disease in Neurological Dept. The primary treatment for epilepsy is by using AEDs. But the treatment duration is long, and the treatment is not accomplished unless the patient has seizure-free for 2 or 3 years. During the long term of AEDs use, some of the drug's adverse effects are emerged, including the effect on the human bone metabolism, which gradually draw peoples'attention. The early report on such subject is all about some enzyme-induced drugs, such as PHT, PB or CBZ. But later more and more research has reported that the enzyme-inhabited drugs, such as VPA, also have an influence on the bone metabolism. Even the newly launched AEDs, including TPM and LTG, which have no effect on the P450 enzyme system, are also reported to be related with the disorder of the bone metabolism. In recent time, there are controversies on the mechanism of this phenomenon, and different conclusions are given by lots of studies.Objective:Compare the changes of bone mineral density and bone metabolism indicators in the epilepsy patients taking VPA for a treatment, in order to analyze the drug's effect on the bone metabolism in different age groups and try to speculate the potential mechanism of this phenomenon. A lot of interferences from the confounding factors are avoided, in order to find the risk factors related to the bone metabolism disorder. In this study, we are trying to speculate the potential mechanism of this issue, and find a guideline to solve similar problems in clinical practice.Method:We have selected 75 patients of epilepsy, who have taken VPA for treatment more than 6 months. All of these patients are seizure-free and show no severe adverse reactions. We have recorded height, weight, period of drug-taken, serum drug concentration of these patients. Bone mineral density of several representive positions, such as vertebral of L2 to L4, femoral neck, trochanter and ward triangle, has been examined, and was recorded in g/cm2. The serum indicators which related to bone metabolism, such as serum calcium, serum phosphorus, ALP and PTH level, has also been tested. Compare the BMD values of different group divided by age segment with the standard values of healthy adults, and analyze the correlations between BMD and other datas, including: period of drug-taken, serum drug concentration and serum indicators related to bone metabolism.Result:①In the male group, BMD values of L2 to L4 vertebral, trochanter and ward triangle have decreased significantly compare with the standard values. In the female group, BMD values of L2 to L4 vertebral and ward triangle have decreased significantly compare with the standard values.②In both male and female group, the incidence of osteopenia and osteoporosis shows no significant differences among groups divided by age segment. The incidence of osteopenia and osteoporosis also shows no significant differences between different genders.③The BMD values of each position, show a negative correlation with the period of drug-taken, but show no significant correlation with the serum drug concentration.④The serum serum calcium, serum phosphorus and ALP level of all patients is in normal range.⑤The BMD values of each position, show no significant correlation with the serum serum calcium, serum phosphorus and ALP level, but show a negative correlation with the PTH level.Conclusion:①As a inhabitor of the P450 enzyme, VPA do has negative effect of bone metabolism of adult epilepsy patients.②The decrease of the BMD value is more obvious in lumbar vertebral, trochanter and ward triangle.③The drug's negative effects upon bone mineral density show no significang differences among different age segments and different genders.④The decrease of the BMD value in long term use of VPA, has a negative correlation with the period of drug-taken, and the serum PTH level too. |
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