UNCONTROLLED SEIZURES AND BONE HEALTH AMONG ADULT EPILEPSY PATIENTS

Abstract

PURPOSE: Uncontrolled seizures negatively impact the quality of life of epilepsy patients, and bone health represents one of the more serious adverse outcomes of epilepsy and its treatment. The objectives of this study were to determine the association between seizure status and bone metabolism and to determine the association between seizure status and the history of fractures. METHODS: A retrospective case-controlled study was conducted. Patient data was collected at the Comprehensive Epilepsy Center at the University of Kansas Medical Center (CEC KUMC). Adult patients with a positive diagnosis of epilepsy (age range 21-50) treated with at least one antiepileptic drug for more than six months were included in the study sample. Patients with a diagnosis of psychogenic nonepileptic seizures, obesity, abnormal liver transaminases, comorbidities and concomitant medications that alter bone metabolism were excluded from participation. The patients' alkaliphosphatase (ALP) level was used as a biomarker for bone metabolism. The case was defined as ALP levels higher than the median ALP levels among the epilepsy patients at the CEC KUMC or positive history of fracture. Logistic regression was used to assess the association and to account for potential confounders. RESULTS: Among 2,607 patients, 161 patients were eligible for this study: 85 cases and 76 controls were identified. Patients with uncontrolled seizures demonstrated 1.964 times higher odds of ALP elevation relative to the odds of ALP elevation among epilepsy patients with well-controlled seizures (95% CI: 1.049-3.680, p=0.0341). Therapeutic category and proportion of enzyme-inducing AEDs were independent risk factors that altered ALP levels. The number of comorbidity, the number of concomitant medications, and the length of epilepsy were considered potential confounders. No association was found between seizure status and prevalence of fractures. CONCLUSIONS: Uncontrolled seizure status is a significant risk factor for alteration of bone metabolism when liver transaminases are normal. Further investigation is necessary to determine the influence of vitamin D intake on ALP elevation and uncontrolled seizures.