Abstracts

Rationale: Patients with epilepsy (PWE) are predisposed to a 2-fold higher risk of fractures due to multiple factors associated with their condition. Previous studies revealed higher prevalence of osteoporosis in PWE than general population. The development of osteoporosis or osteopenia in PWE might be caused by multiple factors including adverse effects of long-term use of antiepileptics (AED) and vitamin D deficiency. However, the effects of chronic cerebral hyperactivity in PWE, has never been well described. Fibromyalgia and osteoarthritis are now considered as conditions resulted from CNS hyperactivity. We hence studied the relationship of osteoporosis development and chronic cerebral activation in PWE diagnosed with localization-related epilepsy. Methods: Retrospective chart review of 340 subjects at age 21-72, men and women, followed at UMDNJ-Robert Wood Johnson UMG epilepsy clinic of one physician (Dr. Brenda Wu) were performed. Results of Dual-Energy X-Ray Absorptiometry (DXA) scan, seizure history, seizure lateralization and control levels as well as overall neuropsychiatric status (insomnia, headaches, anxiety and mood swings, memory lapses) were reviewed. Only 85 subjects (45 women) had DXA scan performed at bilateral femur (hip) and the rest of 75% subjects only had one side femur examined. Bone mineral density of bilateral femoral neck from DXA were studied with correlation of the confirmed seizure onset side per EEG/semiology. Results: About 79% (67/85) subjects had lower BMD at the femoral neck on the affected side (contralateral), correlated to the seizure onset side (example, worse at the left hip in subjects with right frontal seizure onset). Two third of subjects reported that their seizures were relatively well controlled but half of them admitted of having ongoing neuropsychiatric symptoms. Three subjects showed inconsistent lateralization to their typical seizure onset side but more than one epileptic focus were suspected. Conclusions: 1. Central activation may be a cause in osteoporosis independent to AED therapy and may cause systemic focal deficits including low BMD. 2. Like many other systemic illnesses, osteopenia/osteoporosis could be somatic presentation of uncontrolled CNS hyperactivity and could be reversible with appropriate interventions.