Abstract Details

Title A severe bone loss in pharmacoresistant epilepsy associates with enzyme-inducing antiepileptic drug

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-006

Objective

Evaluate the reduction of bone mineral density (BMD) in pharmacoresistant patients exposed to enzyme-inducing antiepileptic drug (EIAED) in Brazil.

Background

Although studies have demonstrated reduced levels of Vitamin-D in patients taking enzyme-inducing antiepileptic drug (EIAED), controversies persist in the bone effects of EIAED.

Design/Methods We examined BMD (according to 2007 ISCD position (https://www.iscd.org/official-positions/2007-iscd-official-positions-adult/) from 59 consecutive adults (41 women, median of 57 years, (range 25-76), duration of epilepsy 45 years) with pharmacoresistant epilepsy who were receiving (or had received) EIAED. Forty-seven subjects aged >50years (>=50y, 41 women). Time of exposure to individual EIAED (median in years, carbamazepine (18years), phenytoin (10.5years) and phenobarbital (4.5years)) was determined and combined as “total-time” (median24years).

Results

Overall, T-score for the femoral neck was -1.2 and -1.55 for the spine.

We identified abnormal BMD in 42 patients (BMD-POS, 25 osteoporosis, and 17 osteopenia). Compared to patients with normal BMD (17 BMD-NL), both groups were balanced for age (p=0.6), sex (p=0.9), race (p=0.26), number of EIAED (p=0.78) and total-time (p=0.7). Among those with osteoporosis, five subjects presented fractures. Abnormal BMD was detected in 71% of post-menopausal women (25/35), divided in osteoporosis (14/35) and osteopenia (11/35).

Considering Group<50-years (9women/3men), osteoporosis was present in 33% and 22% of men and women, respectively. Osteopenia arose in 44% of women. Unfortunately, in the Group>=50years, BMD abnormalities (osteopenia or osteoporosis) occurred in 72% of men (11/15) and 73% of women (23/32). Osteoporosis was diagnosed in 53 and 56% of men and women, respectively.

Conclusions Compared to the expected prevalence of hip osteoporosis (according to World Health Organization) for men (2%) and women (16%) aged ≥50 years, we observed higher proportion (around 50% for men and women) in our study. These preliminary results suggest a severe impact of EIAED on bone density, and alert for the urgent need of a specific policy and guideline to avoid fractures.

Authors/Disclosures
Amanda C. Rigotti, MD PRESENTER	No disclosure on file
Leticia Franceschet Ribeiro	No disclosure on file
Marcia E. Morita-Sherman, MD (Eisai)	An immediate family member of Dr. Morita-Sherman has received personal compensation for serving as an employee of Forrester Research. Dr. Morita-Sherman has received personal compensation for serving as an employee of Eisai Inc.. An immediate family member of Dr. Morita-Sherman has stock in Forrester Research. The institution of Dr. Morita-Sherman has received research support from Cleveland Clinic.
Marina K. Alvim (Hospital Das Clinicas Unicamp)	Dr. Alvim has nothing to disclose.
	No disclosure on file
Carlos A. Guerreiro, MD, FAAN	No disclosure on file
Fernando Cendes, MD, PhD, FAAN (Departamento de Neurologia; FCM; UNICAMP)	Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Biopharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for United Medical – Brazil. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Zodiac Pharma . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eurofarma – Brazil . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology - Epilepsy. The institution of Dr. Cendes has received research support from São Paulo Research Foundation - FAPESP. The institution of Dr. Cendes has received research support from Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil . The institution of Dr. Cendes has received research support from NIH.
Clarissa L. Yasuda, MD, PhD (University of Campinas)	Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for LIBBS. Prof. Yasuda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT. Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for LIBBS.

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