Authors :
Presenting Author: Kenji Sugai, MD, PhD, FAES – Soleil Kawasaki Medical Center for the Severely Disabled
Masako Asoh, MD, PhD – Soleil Kawasaki Medical Center for the Severely Disabled
Natsuko Arai, MD, PhD – Soleil Kawasaki Medical Center for the Severely Disabled
Satomi Ban, MD – Soleil Kawasaki Medical Center for the Severely Disabled
Bunsei Egawa, MD, PhD – Soleil Kawasaki Medical Center for the Severely Disabled
Rationale:
Osteomalacia is a disorder in which mineralization of the bone is selectively impaired, most often due to vitamin D (VD) deficiency. VD metabolism is promoted in the liver by enzyme-inducing antiseizure medication (EIASM) including PHT, CBZ, PB and PRM, leading to VD deficiency. Patients with osteomalacia show elevated alkaline phosphatase (ALP) with low inorganic phosphorus (P) and/or calcium (Ca) in serum. On the other hand, it is said that changes of long-termly administered ASM to another ASM may exacerbate seizures. We studied changes of these indicators and seizure frequency by switching EIASM to non-EIASM (N-EIASM) in severely disabled residents with epilepsy in our institution.
Methods:
The patients had routine blood examination as an annual health screening test every year when specific disease conditions were not present. A total of 20 epileptic patients (14 males) on PHT, CBZ, PB, and/or PRM showed elevated ALP > upper limit with or without low IP and/or Ca. All of them were bed-ridden, aged 28-64 years (median 48) and weighed 23-60 kg (median 44) at withdrawal of all EIASM. None of them had chronic disorders which affect VD metabolism, and none had a high-fat diet or VD supplementation. Eighteen patients had focal or generalized tonic or tonic-clonic seizures, with concomitant FIAS in three patients and with spasms in one patient, and each one patient had clonic seizures and apnea attacks. All their EIASM were switched to LTG, PER, ZNS, bromide and/or LCM, or discontinued. ALP, P, and Ca were examined every 6 to 12 months before and after the withdrawal of EIASM. The mean value of 2 to 4 points during 1 to 2 years before switching ASM and mean value of 2 to 4 points during 2 to 3 years after switching ASMs were compared. Seizure frequency was obtained from medical records described by medical staff, and monthly seizure frequency for 3 months before the initiation of switching ASM and for 3 months in October to December 2024 were compared. Two-trailed paired t tests were applied.
Results:
ALP, P and Ca were significantly improved in all subjects except one case of P after switch of ASM: ALP 124-209 (166+24) to 57-154 (122+26) U/L, p< 0.0001; P 2.1-3.7 (2.9+0.6) to 2.5-3.8 (3.2+0.4) mg/dl, p< 0.005; Ca 8.0-9.2 (8.8+0.4) to 8.6-10.3 (9.1+0.4) mg/dl, p< 0.001. An average monthly seizure frequency decreased from 0-50/month (9.4