Comparison Of The Effects Of Levetiracetam And Valproate On Bone Metabolism In Newly Diagnosed Epileptic Patients

Background: Epilepsy,a common disease of nervous system,a clinical syndrome of highly synchronized abnormal discharge of brain neurons caused by diversified/multiple reasons.It's clinical manifestations are paroxysmal,transient,repetitive and stereotyped.There are about 65 million people with epilepsy worldwide.At present,there are about 9 million patients with epilepsy in China,with an annual incidence of?50 70?/ 100000,a prevalence of about 7‰,and a mortality rate of?1.3 3.6?/ 100000,which is 2³ times of the general population.In recent years,although with the continuous development of medical technology,the treatment of epilepsy is still mainly based on drug therapy.For newly diagnosed patients with epilepsy,single drug treatment/monotherapy should be used as far as possible.Clinical studies in various countries have shown that 70%-80% of newly diagnosed epileptics can be well controlled if they are treated with standard and reasonable AEDs.However,AEDs has a long course of treatment and long-term side effects,one of which is on the bone system and is easily ignored by patients and clinicians.Studies have shown that long-term AEDs treatment can affect bone metabolism,accelerate the loss of bone minerals,and lead to osteoporosis.However,the mechanism of AEDs on bone metabolism is still unclear.In traditional AEDs,enzyme-induced AEDs such as carbamazepine and phenytoin can accelerate vitamin D metabolism through liver enzyme induction to impact bone metabolism.However,the effect of non enzymatically induced AEDs?VPA?and new AEDs?LEV?on bone metabolism is still not clear.As a liver enzyme inhibitor,VPA has been found at home and abroad to affect bone metabolism,but the conclusions are not consistent.Most studies have shown that long-term VPA treatment can affect bone metabolism in epileptic patients.For the moment,there are few studies on bone metabolism of new AEDs LEV and the conclusions are not consistent.Objective: To compare the effects of VPA and LEV on bone metabolism six months later,and to explore the possible pathogenesis so as to provide certain reference for the selection of drugs and bone health care of patients with epilepsy.Methods: From December 2018 to December 2019,57 patients with epilepsy diagnosed in the Department of Neurology,Affiliated Hospital of Yan'an University were randomly divided into two groups,24 of whom in the control group took VPA and 33 of whom took LEV in the experimental group.So the patients' bone metabolism index should be monitored before taking the medicine and after taking the medicine for six months respectively : calcium(Ca²⁺),phosphorus(P^3-),bone formation index?PINP?,bone absorption index??-CTX?and 25 hydroxyvitamin D₃?25?OH?D₃?.SPSS 22.0 statistical software was utilized to analyze the effects of VPA and LEV on bone metabolism in epileptic patients.Results: There were no significant differences in Ca^{2 +}?P^3-?25?OH?D₃,PINP and ?-CTX between control group?VPA group?and the experimental group?LEV group?before treatment?P>0.05?;There were no significant changes in Ca²⁺?P^3-?25?OH?D₃ before and after VPA monotherapy for six months?P>0.05?,while the difference between PINP and ?-CTX is striking and both indexes increased significantly.?P<0.05?;There were no significant differences in Ca²⁺?P^3-?25?OH?D₃?PINP?and ?-CTX in patients with levetiracetam monotherapy before and after 6 months of treatment?P>0.05?.In the LEV and VPA group before and after treatment,Ca²⁺?P^3-?25?OH?D₃ were not statistically significant?P>0.05?,while PINP and ?-CTX were statistically significant?P<0.05?and remarkably discrepant.Conclusion:1.LEV and VPA had no significant effect on serum calcium,serum phosphorus and 25 hydroxyvitamin D₃;2.In VPA group,the bone formation index PINP and bone absorption index ?-CTX were both elevated,which significantly affected bone metabolism and bone health;3.In LEV group,bone formation index PINP and bone absorption index ?-CTX had no significant change and had no significant effect on bone metabolism;4.Compared with LEV group,the effect of VPA group on bone formation index PINP and bone absorption index ?-CTX was significantly different.