Abstracts

Rationale: Epilepsy is one of the most common pediatric neurologic disorders. Childhood epilepsy can affect bone health in several ways. Limited mobility resulting from intractable epilepsy or associated co-morbidities such as cerebral palsy, ketogenic diet and antiepileptic polypharmacy are common risk factors for vitamin D deficiency and fractures in childhood epilepsy. This study was performed to assess the profile of metabolic bone disease and fractures in children with epilepsy.

Methods: This study was performed as part of a quality improvement project to assess different aspects of bone health in children with epilepsy. We identified patients with epilepsy, less than 18 years and co-morbid possible metabolic bone disease or fractures through an electronic health record search Patients with ICD-10 code of G40.* were matched with any of the following ICD-10 codes S 32, S 42, S 52, S72, S 82 (all representing fracture codes), E83.51 (hypocalcemia) and E55.9 (vitamin D deficiency). Individual matches were verified and demographic and clinical data extracted from electronic health records between 2015-2020 for both hospital admissions and outpatient visits.

Results: A total of 102 patients were identified: 56 patients with fractures, 19 with Vitamin D deficiency and 22 with hypocalcemia and five with combined hypocalcemia and vitamin D deficiency. In patients with childhood epilepsy, fractures were caused by accidental trauma (5), non-accidental trauma (5), falls (17), seizure leading to falls (4), sports-related injury (4) minor trauma with diffuse osteopenia (21). Race was  Black (17), White (38) and  Asian (1). 13 patients were on Vitamin D supplementation at the time of fracture, and 15 patients had previous history of fractures. 16/56 were wheelchair bound or mobile with assistance at the time of the fracture. Only one patient with fractures was on the ketogenic diet. 39 patients with fractures were on 2 or more antiepileptic drug.

Conclusions: A significant percentage of children with epilepsy presenting with fractures were not on Vitamin D supplements at the time of presentation and most fractures were related to falls or minor trauma. Implementation of alerts in electronic health records to assess bone health in children with epilepsy and antiepileptic polypharmacy might decrease the incidence of fractures in this population.

Funding: This work was funded by an institutional KPRI quality improvement grant from the Department of Pediatrics, Children Hospital of Alabama.