Assessment of bone mineral density disorders in children with cerebral palsy, epilepsy and cerebral palsy with epilepsy

AIM: The aim of this study was searching bone metabolism and mineral density disorders; determining the effect of possible risk factors such as immobilization, mental retardation, calcium and vitamin D deficiency, anti-epileptic drug using in children with cerebral palsy, epilepsy and cerebral palsy- epilepsy before clinical findings arise; investigating the demand of prophylactic treatment in patients who may develop osteoporosis.MATERIAL AND METHOD: Between of 2009 November and 2011 April, prepubertal 122 patient aged 3-14 with cerebral palsy, epilepsy and cerebral palsy-epilepsy diagnosis and a control group of 30 patients were included in this research at Adnan Menderes University Medical Faculty - Pediatric Neurology Department. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), 25 OHD3, parathormone (PTH) levels were evaluated and bone mineral density were assessed by dual energy X-ray absorptiometry (DEXA).RESULTS: 3th Class malnutrition was existent in %11 of patients with epilepsy, %36,7 of patients with cerebral palsy, %44,7 of patients with cerebral palsy concomitant with epilepsy. It was detected that higher KMFSS level causes high malnutrition rates (p<0,05). Serum Ca levels of cerebral palsy and epilepsy-cerebral palsy group was detected significantly lower than epilepsy and control group. Highest ratio (%63,2) of vitamin D deficiency and insufficiency was detected in epilepsy-cerebral palsy group. The mean serum 25 OHD3 level was significantly lower in patients receiving more than one anticonvulsant than in those receiving a single drug (p < 0.05). Significant correlation was detected in between vitamin D levels and sunlight, Ca levels, KMFSS; however, there was no significant correlation between Ca , KMD and seasons (p>0,05). Abnormal BMD was found in 61 patients (50%). Lack of autonomous gait, mental retardation, long duration of AED, VPA, TPM and LTA adjunctive therapy significantly correlated with abnormal BMD.IN CONCLUSION: Cerebral palsy patients who have low daily activity, fracture history, mental retardation, nutrition disorder and antiepileptic drug history have higher risk for lower KMD. Vitamin D levels should be evaluated in such patients and these patients must be assessed for KMD periodically. Prophylactic vitamin D should be initiated particularly in patients with cerebral palsy and epilepsy who prescribed polytherapy.Key words: Cerebral palsy, epilepsy, bone mineral density