الفهرس 
Classification of Epileptic SeizuresOnly 14 pages are availabe for public view
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Abstract
Epilepsy is one of the most common neurological disorders in the pediatric age group. It is also a major public health problem affecting the children world wide. By the neurobiologic, cognitive, psychologic and social consequences of epilepsy, it is considered to be a serious neurologic disorder that often requires lifelong treatment. Anti epileptic drugs are frequent and selection of antiepileptic drug is a challenging task. Age, sex, type of seizures and presence of other medical conditions should be considered during choice of antiepileptic drug. The aim of epilepsy management is complete seizure cessation and maintenance of a good quality of life, which is affected not only by the epileptic attacks but also by adverse effect of the drugs. Treatment with anti epileptic drugs (AEDs) is generally chronic, if not lifelong and may be associated with significant metabolic effects including decreased bone mass and increased bone fractures. AEDs include a variety of drugs that may lead to catabolism of vitamin D and hypocalcemia. In addition, many of these medications such as the benzodiazepines -carbamazepine and clonazepam- and barbiturates, are currently utilized in disorders other than epilepsy such as pain and mood disorders, so hypovitaminosis D with treatment of antiepileptic drugs is a general problem. Summary and conclusion 162 Vitamin D has been considered as neurosteroid, and its role in neuroprotection, brain development, and immunomodulation has been noticed in many studies; however, our knowledge regarding its role in neurological disorders is still developing. The potential role of vitamin D in the pathophysiology and treatment of epilepsy, as one the most prevalent neurological disorders, has received less attention in recent years. In this study patients were assessed by measuring the chemical parameters of bone metabolism including (serum calcium, phosphorus, alkaline phophatase, parathyroid hormone and 25-OH Vitamin D) after at least 12 months of chronic use of (Valproic acid, Carbamazepine, Levetiracetam and Topiramate) as monotherapy antiepileptic drug and comparing them by healthy control children. This study was carried out in Tanta University Hospital, Pediatric Department, Neurology Unit. In this study, one hundred (100) children with idiopathic epilepsy on chronic use of AEDs: carbamazepine, valproic acid, levetiracetam and topiramate for at least one year of treatment were selected from those attending the pediatric neurology out-patient clinic and were enrolled in the study with the age range from 6-15 years. These patients were grouped according to their antiepileptic drug treatment into four groups : Summary and conclusion 163 group 1, thirty (30) patients received valproic acid as monotherapy without any other antiepileptic drug. group 2, thirty (30) patients received carbamazepine as monotherapy without any other antiepileptic drug. group 3, twenty (20) patients received levetiracetam as monotherapy. group 4, twenty (20) patients received topiramate as monotherapy. Fifty (50) healthy children with the same age and sex were served as control group. Children with idiopathic epilepsy with normal Magnetic Resonance Imaging (MRI) brain and with well controlled epilepsy were included. Children with metabolic bone diseases, with renal, hepatic, endocrinal diseases, children with epilepsy who are seizure free and off medications, or children with vitamin D supplementation were excluded. In the present study there was significant decrease in serum calcium and phosphorus level in patients treated with valproic acid and carbamazepine as monotherapy for at least one year in comparison with the control group while there was no significant difference between Summary and conclusion 164 serum calcium and phosphorus levels between patients treated with levetiracetam and topiramate as monotherapy for at least one year and the control group. Regarding alkaline phosphatase and parathormone level, there was significant increase in their serum level in Valproic acid and carbamazepine treated groups in comparison with the control group while there was no significant difference between levetiracetam and topiramate treated groups and the control. Also regarding serum 25-OH vitamin D level, this study showed significant decrease in its level in both valproic acid and carbamazepine treated groups when compared with the control group while there was no significant difference between levetiracetam and topiramate treated groups and the control group. Also, there was inverse correlation between the duration of treatment with valproic acid and carbamazepine and the mean level of 25-OH Vitamin D. The longer the duration of treatment, the lower the mean level of vitamin D. from this study we conclude that vitamin D deficiency is relatively common in children with epilepsy -without abnormal underlying conditions- who had received valproate or carbamazepine as a monotherapy for at least twelve months. Summary and conclusion 165 Also this study showed inverse correlation between serum 25-OH Vitamin D level and duration of treatment with valproic acid and carbamazepine. The longer the duration of treatment, the more significant decrease in mean 25-OH Vitamin D level.