Prevalence of Hypocalcemia and Raised Serum Alkaline Phosphatase Levels Among Children Taking Antiepileptic Drugs

Hafiz Aaqib Mehboob; Sohail Ashraf; Haisam Khan; Shiza Safdar

doi:10.70749/ijbr.v3i5.1182

Authors

Hafiz Aaqib Mehboob Department of Pediatrics, POF Hospital, Wah Cantt, Punjab, Pakistan.
Sohail Ashraf Department of Pediatrics, POF Hospital, Wah Cantt, Punjab, Pakistan.
Haisam Khan Department of Pediatrics, POF Hospital, Wah Cantt, Punjab, Pakistan.
Shiza Safdar Department of Pediatrics, POF Hospital, Wah Cantt, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1182

Keywords:

Epilepsy, Antiepileptic Drugs, Hypocalcemia, Alkaline Phosphatase

Abstract

Background: Epilepsy in children is treated by antiepileptic drugs, which cause imbalances of mineral metabolism such as hypocalcemia and acquired elevated alkaline phosphatase levels. These biochemical markers need careful monitoring to interpret the long-term outcomes of the treatment of AED. Objective: To determine the frequency of hypocalcemia and raised serum alkaline phosphatase among children with epilepsy taking anti-epileptic drugs in a tertiary care hospital. Study Design: Descriptive cross-sectional study. Duration and Place of Study: The study was conducted from November 2023 to May 2024 at the Department of Pediatrics, POF Hospital, Wah Cantt. Methodology: A total of 91 children aged 3 to15 years, diagnosed with epilepsy and receiving AEDs for at least six months, were included in the study. Serum calcium and ALP levels were measured, and their prevalence was assessed. Results: The mean age of the patients was 8.76 ± 3.30 years, with 67% of children shown hypocalcemia and 69.2% showing elevated ALP levels. The prevalence of hypocalcemia was highest in children on phenobarbital (84%), followed by valproic acid (71.4%) and carbamazepine (48.4%). Conclusion: Our study found a strong link between chronic antiepileptic drug (AED) use and bone metabolism disturbances, such as elevated alkaline phosphatase and hypocalcemia. Classical AEDs like valproic acid and phenobarbital significantly affect bone health. Regular monitoring of children on long-term AEDs is recommended, with possible vitamin D and calcium supplementation. Further research with larger, multi-centered populations is needed to validate these findings and guide appropriate interventions.

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References

Vetri, L., Roccella, M., Parisi, L., Smirni, D., Costanza, C., Carotenuto, M., & Elia, M. (2023). Epilepsy: A multifaced spectrum disorder. Behavioral Sciences, 13(2), 97.

https://doi.org/10.3390/bs13020097

Biset, G., Abebaw, N., Gebeyehu, N. A., Estifanos, N., Birrie, E., & Tegegne, K. D. (2024). Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: A systematic review and meta-analysis. BMC Public Health, 24(1).

https://doi.org/10.1186/s12889-024-18236-z

Rozensztrauch, A., & Kołtuniuk, A. (2022). The quality of life of children with epilepsy and the impact of the disease on the family functioning. International Journal of Environmental Research and Public Health, 19(4), 2277.

https://doi.org/10.3390/ijerph19042277

Almannai, M., Al Mahmoud, R. A., Mekki, M., & El-Hattab, A. W. (2021). Metabolic seizures. Frontiers in Neurology, 12.

https://doi.org/10.3389/fneur.2021.640371

Dima, S. A., & Shibeshi, M. S. (2022). Antiepileptic drug adherence in children in Southern Ethiopia: A cross sectional study. PLOS ONE, 17(2), e0263821.

https://doi.org/10.1371/journal.pone.0263821

Perdani, R. R., Arozal, W., Mangunatmadja, I., Kaswandani, N., Handryastuti, S., Medise, B. E., Hardi, H., Thandavarayan, R. A., & Oswari, H. (2023). The efficacy and safety of first-line anti-seizure medications as substitution therapy for children with drug-resistant epilepsy: A randomized controlled trial protocol. Frontiers in Neurology, 14.

https://doi.org/10.3389/fneur.2023.1237183

Belete, T. M. (2023). Recent progress in the development of new Antiepileptic drugs with novel targets. Annals of Neurosciences, 30(4), 262-276.

https://doi.org/10.1177/09727531231185991

Manole, A., Sirbu, C., Mititelu, M., Vasiliu, O., Lorusso, L., Sirbu, O., & Ionita Radu, F. (2023). State of the art and challenges in epilepsy—A narrative review. Journal of Personalized Medicine, 13(4), 623.

https://doi.org/10.3390/jpm13040623

Wakeman, M. (2021). A literature review of the potential impact of medication on vitamin D status. Risk Management and Healthcare Policy, 14, 3357-3381.

https://doi.org/10.2147/rmhp.s316897

Tinawi, M. (2021). Disorders of calcium metabolism: Hypocalcemia and hypercalcemia. Cureus.

https://doi.org/10.7759/cureus.12420

Minz, P., Oroan, A., Kujur, A., Paswan, D. K., & Nag, A. R. (2023). Effects of anticonvulsant drug on liver enzymes among children in a tribal state of India: A longitudinal study. Journal of Family Medicine and Primary Care, 12(7), 1394-1398.

https://doi.org/10.4103/jfmpc.jfmpc_2307_22

Joshi, M., & Uday, S. (2023). Vitamin D deficiency in chronic childhood disorders: Importance of screening and prevention. Nutrients, 15(12), 2805.

https://doi.org/10.3390/nu15122805

Ghannam, M., Mansour, S., Nabulsi, A., & Abdoh, Q. (2017). Anticonvulsant hypersensitivity syndrome after phenytoin administration in an adolescent patient: A case report and review of literature. Clinical and Molecular Allergy, 15(1).

https://doi.org/10.1186/s12948-017-0069-0

Fan, H., Lee, H., Chang, K., Lee, Y., Lai, H., Hung, P., Lee, H., & Chi, C. (2016). The impact of anti-epileptic drugs on growth and bone metabolism. International Journal of Molecular Sciences, 17(8), 1242.

https://doi.org/10.3390/ijms17081242

Zia, T, Ikram, O, Ghazal, N. (2020). Serum calcium and alkaline phosphatase levels in patients taking antiepileptic drugs. Indo Am J P Sci, 7, 1065-71.

Rani, T., Qudrat, S. M., Aziz, S., Um Min Allah, N., Khalid, A., & Tabassum, M. (2023). Children on anti epileptic drugs have low serum calcium and raised alkaline phosphatase levels. Journal of Rawalpindi Medical College, 27(1).

https://doi.org/10.37939/jrmc.v27i1.1614

Muhammad, S. J., Ali, S. H., & Shareef, L. G. (2022). Comparison between the effects of older versus newer generations of antiepileptic drugs on bone metabolism in adult Iraqi patients: An observational study. F1000Research, 11, 572.

https://doi.org/10.12688/f1000research.122089.1

Gupta, A., Mahajan, S., & Neki, N. S. (2019). To Study the Effect of Antiepileptic Drugs on Serum Alkaline Phosphatase Levels in the Epileptic Patients. Ann Int Med Dent Res, 5(3), 8-9.

https://pesquisa.bvsalud.org/portal/resource/pt/sea-189298

Schmitt, B. P., Nordlund, D. J., & Rodgers, L. A. (1984). Prevalence of hypocalcemia and elevated serum alkaline phosphatase in patients receiving chronic anticonvulsant therapy. Journal of Family Practice, 18(6), 873-877.

https://cdn-uat.mdedge.com/files/s3fs-public/jfp-archived-issues/1984-volume_18-19/JFP_1984-06_v18_i6_prevalence-of-hypocalcemia-and-elevated.pdf