E0029451

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Not Applicable (or Unknown)

コウ テンカンザイ チョウキ フクヨウ ニオケル クルビョウ ハッショウ ヨウイン ニカンスル リンショウテキ ケンキュウ

A study on anticonvulsant-induced rickets and treatment

Japanese (日本語)

Medical journal of Kobe University

47(1)

25-33

1986-03

Rickets or osteomalacia has shown to be associated with long-term anticonvulsant therapy. lt was the purpose of this study to elucidate the factor which lead to rachitic changes and to determine the effect of 1α-Hydoxyvitamin D (1α-OH-D_3) on patients suffering from slight osteomalacia found out from epileptic patients. The authers measured the serum concentrations of calcium (Ca), phosphorus (P), alkaline-phosphatase (Al-p), 25-Hydroxyvitamin D (25-OH-D), and evaluated ΣGS/D (index of bone density) and MCI (metacarpal index) using microdensitometry method. The patients were 92 epileptic children aged 3 to 22 yrs (mean 10.5 yrs old) who had been recieving various combinations of anticonvulsants for at least 3 yrs (mean 5.8 yrs). 1α-OH-D_3 was given to 16 of the above mentioned patients showed low levels of serum 25-OH-D (below -2SD) or low ΣGS/D values for metacarpal bone (below -1.65SD). The obtained results are as follows. 1) Serum Ca levels decreased with a duration of therapy and were lower in 21 patients (22.8%) compared with age matched controls. Serum Al-p levels were higher in 5 patients (6.5%) aged 6 to 14 yrs. Serum 25-OH-D levels decreased with a duration of therapy and with age and were low in 17 patients (18.5%). 2) In 11 patients (13.4%), the ΣGS/D values were low and almost all cases were 9 to 14 years old, who were recieved PB or PB with other anticonvulsant drugs for more than 7 yrs and had been medicated from earlier age than other patients. In 8 (72.7%) of 11 patients had showed low levels of serum 25-OH-D. 3) Serum Ca levels had significantly increased from 9.0 mg/dl to 9.3 mg/dl at 3 mos after taking 1α-OH-D_3. Serum levels of P and Al-p did not vary before or after treatment with 1α-OH-D_3. 4) Serum 25-OH-D levels significantly increased from 15.8 ng/ml to 26.7 ng/ml, similar to the levels in controls. 5) The ΣGS/D values of patients on treatment with 1α-OH-D_3 for 18 mos were higher than those of controls and healthy children. There was no difference in the MCI values between patients with 1α-OH-D_3 and controls. These results suggest that long-term treatment with PB or PB with other anticonvulsant drugs and patient's age are the factors leading to rachitic changes and evaluations of ΣGS/D together with those of Ca, Al-p and 25-OH-D are useful for early detection of rachitic changes, Treatment with 1α-OH-D_3 improves the bone density in epileptic children undergoing long-term anticonvulsant therapy.

1α-OH-D_3

紀要論文