title: Evaluation and management of bone health in children with epilepsy on long-term antiepileptic drugs: United Kingdom survey of paediatric neurologists.
abstract: OBJECTIVE
  Current evidence indicates long-term use of antiepileptic drugs (AEDs) is associated with impaired childhood bone health. The objective of this study was to ascertain the current clinical practice of paediatric neurologists managing children with epilepsy on long-term (>2 years) AED therapy, particularly against the UK Medicines and Healthcare products Regulatory Agency (MHRA) current recommendation of vitamin D supplementation in patients on long-term AEDs at-risk of impaired bone health.
  
  
  METHODS
  An internet-based survey of UK paediatric neurologists who routinely see children with epilepsy (n = 95) covered clinicians' epilepsy case-load and reflection on their current clinical practice with estimation of the frequency with which they considered various bone health issues. Responses were graded as 'frequent'(≥50%), 'sometimes'(25%-50%) and 'infrequent'(<25%).
  
  
  RESULTS
  Overall response rate was 72/95 (76%). 3% frequently recommend prophylactic calcium and vitamin D supplementation, 6% frequently perform bone screening investigations, 7% frequently give bone health advice and 10% frequently enquire about skeletal risk factors. Clinical practices were not associated with epilepsy caseload (p-values 0.44-1). 84% infrequently performed bone health screening investigations. 54% of respondents indicated that, if performed, 100% would undertake bone profile, 64% 25(OH) Vitamin D, 18% PTH, 49% dual energy X-ray absorptiometry (DEXA) scan and 13% bone X-ray.
  
  
  CONCLUSIONS
  The majority of paediatric neurologists do not routinely consider bone health related issues in children on long-term AEDs. Greater emphasis should be placed on vitamin D supplementation in these children.
authors.affiliation: Department of Paediatric Neurology, Bristol Royal Hospital for Children, UK.
authors.forename: Choong Yi
authors.initials: CY
authors.lastname: Fong
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Mallick
authors.forename: Christine P
authors.initials: CP
authors.lastname: Burren
authors.forename: Jayesh S
authors.initials: JS
authors.lastname: Patel
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D001847:Bone Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D002648:Child; D004827:Epilepsy / Q000188:drug therapy*; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D009462:Neurology / Q000379:methods* / Q000592:standards; D010372:Pediatrics / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000639:trends; D011314:Preventive Health Services / Q000379:methods / Q000639:trends; D011859:Radiography; D011795:Surveys and Questionnaires / Q000592:standards; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants