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This study aimed to investigate whether carbamazepine, sodium valproate or phenobarbital as monotherapy in ambulatory epileptic children with adequate sun exposure have some effect on their bone metabolism based on the determination of total serum alkaline phosphatase (AP) levels and its bone isoenzyme activity. Blood samples were obtained from 118 epileptic children (37 on carbamazepine, 47 on sodium valproate and 34 on phenobarbital) and from corresponding healthy controls matched for age, gender and anthropometric parameters. AP and its liver, bone and intestinal isoenzyme levels, other common biochemical markers of bone and liver metabolism and drug levels were measured in the study participants. Patients on carbamazepine or phenobarbital had significantly elevated AP levels accompanied by increased bone and liver isoenzyme activity compared to controls. An increase of bone AP isoenzyme values, correlated with the duration of treatment (r = 0.49, P = 0.002), was found in children on sodium valproate without, however, a concomitant significant elevation of total AP values. We conclude that children who receive antiepileptic drugs as monotherapy, even when residing in a Mediterranean country with adequate sunlight, may have their bone metabolism affected as indicated by the elevated levels of bone AP isoenzyme. This isoenzyme, but not total AP values, could therefore be used as a marker for the selection of patients who would be benefited by a thorough evaluation of their bone metabolism profile. © 2002 Published by Elsevier Science Ltd on behalf of BEA Trading Ltd. Patients:118 ambulatory children, aged 12 months to 14 years. 37 patients (mean age +/- SD: 8.08 +/- 3.65) were receiving carbamazepine monotherapy. 118 clinically healthy children served as the control group (37 served as the control group for the Tegretrol based treatment group). Indications:Treatment of epilepsy among 37 children. TypeofStudy:To study the effect of Tegretrol on bone metabolism among children treated for epilepsy. DosageDuration:Dosage and duration not stated. ComparativeDrug:phenobarbital and sodium valproate Results:Total serum alkaline phosphatase (AP), bone alkaline phosphatase (AP-B) and liver alkaline phosphatase (AP-L) isoenzyme levels were significantly higher among children receiving Tegretrol compared to the corresponding control group. Total AP levels correlated significantly to both bone and liver AP enzymes. Serum calcium (Ca), phosphorus (P), alanine aminotrasferase (SGOT) and aspartate aminotransferase (SGPT) did not show any signofocant difference whereas serum gamma glutamyltransferase (GGT) was significantly higher in children on Tegretrol. AdverseEffects:Elevated serum AP, AP-B, and AP-L isoenzyme and GGT levels were noted. AuthorsConclusions:AP bone isoenzyme activity, but not total serum AP levels, could be considered as a useful marker for the monitoring of bone metabolism alterations in children on antiepileptic drug monotherapy. FreeText:Blood sample was obtained after 12 hours fasting in early morning, between 8:00 and 10:00 am. Serum Ca, P, GGT, SGOT, SGPT, AP, AP-B, AP-L, and AP intestinal isoenzyme levels were determined in all specimens whereas drug levels were measured in epileptic children. |
