Abstracts

Vitamin D deficiency may be common in people with epilepsy (PWE) treated with antiepileptic drugs (AEDs). It is not clear when to evaluate PWE for vitamin D deficiency. There is almost no information regarding treatment of Vitamin D deficiency in this situation. Serum 25 OH Vitamin D levels, total alkaline phosphatase, total calcium, and phosphorus were obtained in all PWE with 2 or more risk factors for osteoporosis or osteomalacia seen at an outpatient clinic by one of the authors. If Vitamin D deficiency was present (25 OH Vitamin D [lt] 20 ng/ml), parathyroid hormone (PTH) levels were obtained in some subjects and 1200 IU Vitamin D daily was prescribed to all. Serum 25 OH Vitamin D levels and other chemistries were repeated approximately every 3 months. 91/307 PWE seen during 6 months had multiple risk factors for bone disease. 32/91 (35%) had 25 OH Vitamin D levels [lt] 20 ng/ml including 7 (8%) with 25 OH Vitamin D [lt] 10 ng/ml. No subjects had hypocalcemia. Only 5/15 with Vitamin D deficiency had elevated PTH ([gt]65 pg/ml). 10/32 Vitamin D deficient subjects and 13/59 subjects with normal Vitamin D had abnormally elevated alkaline phosphatase (p=0.41). 26/32 Vitamin D deficient subjects and 41/59 subjects with normal vitamin D were treated with one or more inducing AEDs (p=0.22). Age, sex, body mass index, and fraction residing in group homes also did not differ in PWE with and without Vitamin D deficiency. 25 OH Vitamin D levels after [gt]3 months of treatment with 1200 IU of Vitamin D are currently available in 15/32 subjects presenting with Vitamin D deficiency. 25 OH Vitamin D increased from a mean 14ng/ml to a mean 43ng/ml. All subjects had levels [gt] 20 ng/ml, 8/15 had levels [gt] 35 ng/ml and 2 had levels [gt] 60 ng/ml (maximum 69) following treatment. Mean alkaline phosphatase prior to (102+-48.5) and following (97+-26) Vitamin D treatment didn[rsquo]t differ significantly (p=0.62); alkaline phosphatase remained abnormally elevated in 5/15. Serial 25 OH Vitamin D and alkaline phosphatase determinations are ongoing to evaluate the possibility of cumulative toxicity and the impact of seasonal variation of light. Impact of other risk factors for bone disease will be discussed. Vitamin D deficiency is common in PWE treated with AEDs who have multiple risk factors for bone disease; however it appears to be relatively mild. 1200 IU Vitamin D normalized Vitamin D levels in all subjects in this study. Higher doses may be needed at higher geographical latitudes or to achieve optimal levels ([gt]35ng/ml) in some patients. Persistently elevated alkaline phosphatase following correction of Vitamin D deficiency suggests that abnormalities in Vitamin D metabolism are not the only cause of bone disease in PWE. (Supported by MINCEP[reg] Epilepsy Care)