24-25-dihydroxyvitamin-d-3 and Epilepsy

Vitamin D deficiency is not only associated with the adverse effects of chronic treatment with antiepileptic drugs (AEDs), but also with epilepsy. Although emerging evidence suggests that AEDs can accelerate the vitamin D catabolism, resulting in suboptimal vitamin D status, there are a limited number of studies examining the vitamin D status in epileptic patients, especially in first-episode or AEDs-naïve children.. Determined with high-performance liquid chromatography-tandem mass spectrometry, circulating 25(OH)D3 and 24,25(OH)2D3 levels, and 24,25(OH)2D3:25(OH)D3 ratio were compared between AEDs-treated epileptic (n = 363) and control (n = 159) children. To further figure out whether the patients were in a vitamin D deficient prone state even before treatment, epileptic children before their initiation of treatment (n = 51) were enrolled into a follow-up study.. A significant decrease of 25(OH)D3 and 24,25(OH)2D3 levels, but a significant increase of 24,25(OH)2D3:25(OH)D3 ratio was observed in epileptic children, compared with controls. Baseline 25(OH)D3, 24,25(OH)2D3 and 24,25(OH)2D3:25(OH)D3 ratio in the follow-up group were similar to those in controls, but significantly changed with 2 months of AED therapy.. Disturbed vitamin D levels were possibly the consequence of AED therapy, rather than the contributing factor of epilepsy. Collectively, circulating vitamin D levels should be monitored and corrected in AEDs-treated epileptic children.

Topics: 24,25-Dihydroxyvitamin D 3; Anticonvulsants; Calcitriol; Child; Child, Preschool; Chromatography, High Pressure Liquid; Epilepsy; Female; Follow-Up Studies; Humans; Infant; Male; Nutritional Status; Tandem Mass Spectrometry; Vitamins

Serum concentrations of vitamin D metabolites were measured before and during treatment with either vitamin D2 or vitamin D3, 4000 IU per day for 24 weeks, in 22 epileptic outpatients receiving phenobarbitone/phenytoin. The serum concentration of total 1,25(OH)2D did not change during the treatment period in any of the treatment groups. On the other hand, in the vitamin D2 group, serum 25(OH)D2, total 25(OH)D, and 24,25(OH)2D increased significantly during the trial, whereas serum concentrations of the vitamin D3 metabolites were unchanged. In the vitamin D3 group, serum concentrations of the vitamin D3 metabolites increased significantly, whereas the vitamin D3 metabolite levels remained unchanged. However, vitamin D3 treatment resulted in a 2-4-fold greater increase in serum concentrations compared to vitamin D2 treatment. Treatment with vitamin D2 and vitamin D3 in the same dose in IU results in considerably different serum concentrations of the vitamin D metabolites.

Topics: 24,25-Dihydroxyvitamin D 3; 25-Hydroxyvitamin D 2; Adult; Aged; Calcifediol; Calcium; Cholecalciferol; Dihydroxycholecalciferols; Epilepsy; Ergocalciferols; Female; Humans; Male; Middle Aged; Phenobarbital; Phenytoin

Serum concentrations of the main vitamin D metabolites and of calcium, phosphate, and alkaline phosphatase were determined in each of the three trimesters of pregnancy and in simultaneously obtained maternal and cord blood at delivery in 22 epileptic women treated with diphenylhydantoin or carbamazepine alone or with a combination with one other drug. The results were compared with similarly obtained data from 22 normal pregnancies. Women in both groups received supplements of 400 IU vitamin D3 per day. All the women had 25-hydroxyvitamin D levels within the normal range for healthy adults (greater than 12 ng/ml) throughout pregnancy. The epileptic women had, however, significantly (p less than 0.05) lower median 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and higher median 25,26-dihydroxyvitamin D values than the reference group. The 24,25-dihydroxyvitamin D concentrations did not differ significantly, but the median ratio of 24,25-dihydroxyvitamin D to 25-hydroxyvitamin D was higher in the epileptic women at the end of pregnancy (p = 0.05). The respective differences in cord serum concentrations reflected those of the mothers at delivery. Serum calcium tended to be lower during epileptic pregnancy, but none were hypocalcemic. The alkaline phosphatase and phosphate values did not consistently differ from those of the reference women. The median alkaline phosphatase level of cord serum was slightly higher in the epileptic group, but the calcium and phosphate levels were similar to the reference values. The various biochemical parameters of the carbamazepine-treated women tended to be intermediate between those of the healthy and diphenylhydantoin-treated groups. Antiepileptic drug therapy appears to affect vitamin D metabolism and calcium homeostasis during pregnancy. The derangements may not be of major clinical significance, however, in vitamin D-supplemented and normally functioning women on long-term low-dose therapy.

Topics: 24,25-Dihydroxyvitamin D 3; Adolescent; Adult; Alkaline Phosphatase; Anticonvulsants; Calcifediol; Calcitriol; Calcium; Carbamazepine; Cholecalciferol; Dihydroxycholecalciferols; Epilepsy; Female; Fetal Blood; Homeostasis; Humans; Phenytoin; Phosphates; Pregnancy; Pregnancy Complications; Vitamin D

The serum concentrations of the vitamin D metabolites 25-hydroxyvitamin D (25OHD), 24,25-dihydroxyvitamin D (24,25(OH)2D), and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured in 18 epileptic patients and 10 controls. The patients were divided according to the anti-convulsant treatment they had been receiving for at least 1 year: 9 patients had received phenytoin and 9 patients carbamazepine, as the sole anti-convulsant therapy. The serum 25OHD was decreased in the patients on phenytoin (P less than 0.01), whereas the other serum vitamin D metabolites were normal. Moreover, serum alkaline phosphatase was increased (P less than 0.001) and serum calcium was decreased (P less than 0.001) in this patient group. In the patient group treated with carbamazepine (a negligible, liver inductor), changes in serum 25OHD and serum alkaline phosphatase were less pronounced (P less than 0.05), but the same degree of hypocalcaemia (P less than 0.001) was present. Our data suggest that liver induction in epileptic patients on anti-convulsant drugs cannot explain the pathophysiology behind anti-convulsant osteomalacia.

Topics: 24,25-Dihydroxyvitamin D 3; Adult; Aged; Alkaline Phosphatase; Calcifediol; Calcitriol; Calcium; Carbamazepine; Dihydroxycholecalciferols; Epilepsy; Female; Humans; Male; Middle Aged; Osteomalacia; Phenytoin

The efficacy of vitamin D2 in the dose of 2000 IU daily in reversing anticonvulsant osteomalacia was studied in nine epileptic inpatients. The treatment with vitamin D2 was associated with increased serum 25-hydroxycalciferol and 24,25-dihydroxyvitamin D concentrations and partial healing of osteomalacic changes in the cancellous bone of the iliac crest. But it was concluded that the dose of vitamin D2, 2000 IU daily, was too small and that calcium supplementation may be needed in addition to vitamin D therapy.

Topics: 24,25-Dihydroxyvitamin D 3; Adult; Alkaline Phosphatase; Anticonvulsants; Bone and Bones; Calcifediol; Calcium; Dihydroxycholecalciferols; Epilepsy; Ergocalciferols; Female; Humans; Male; Middle Aged; Osteomalacia; Phosphates

Thirty-one adult epileptic outpatients on chronic combined anticonvulsant therapy were investigated. Eleven patients took vitamin D2 supplementation 400-1200 IU/day as multivitamin tablets. Mean serum calcium and renal calcium excretion were reduced. Serum alkaline phosphatase and urinary hydroxyproline excretion were increased. Forearm bone mineral content was reduced. Serum concentrations of 25-hydroxyvitamin D (25-OHD), 24-25-dihydroxyvitamin D (24,25-(OH)2D) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) were reduced (p less than 0.001). A positive correlation was found between the serum 25-OHD and 24,25-(OH)2D concentrations (p less than 0.05) with the highest levels in those receiving vitamin D2 supplementation (p less than 0.01). Serum 1,25-(OH)2D correlated positively with renal calcium excretion (r = 0.65, p less than 0.001) suggesting that the intestinal calcium absorption in epileptic patients depends on 1,25-(OH)2D levels.

Topics: 24,25-Dihydroxyvitamin D 3; Adult; Alkaline Phosphatase; Anticonvulsants; Calcifediol; Calcitriol; Calcium; Dihydroxycholecalciferols; Drug Therapy, Combination; Epilepsy; Ergocalciferols; Female; Humans; Hydroxycholecalciferols; Hydroxyproline; Male; Middle Aged