title: Potential effects of valproate and oxcarbazepine on growth velocity and bone metabolism in epileptic children- a medical center experience.
abstract: Children with longstanding use of antiepileptic drugs (AEDs) are susceptible to developing low bone mineral density and an increased fracture risk. However, the literature regarding the effects of AEDs on growth in epileptic children is limited. The aim of this study was to investigate the potential effects of valproate (VPA) and/or oxcarbazepine (OXC) therapy on growth velocity and bone metabolism.
  
  
  
  Seventy-three ambulatory children (40 boys and 33 girls) with epilepsy, aged between 1 and 18 years (mean age 9.8 ± 4.1 years), were evaluated for growth velocity before and for 1 year after VPA and/or OXC treatment. The bone resorption marker serum tartrate-resistant acid phosphatase 5b (TRAcP5b) and the bone formation marker serum bone-specific alkaline phosphatase (BAP) were measured post-AEDs therapy for 1 year.
  
  
  
  The difference in growth velocity (ΔHt) and body weight change (ΔWt) between pre- and post-AEDs treatment were -1.0 ± 2.8 cm/year (P < 0.05) and 0.1 ± 3.9 kg/year (P = 0.84), respectively. The study population had serum TRAcP5b-SDS of -1.6 ± 1.2 and BAP-SDS of 1.7 ± 3.7 compared with sex- and age-matched healthy children. Significant correlation between serum TRAcP 5b and BAP activities was noted (r = 0.60, p < 0.001). There was a positive correlation between growth velocity and serum TRAcP 5b activity after AED treatment (r = 0.42, p < 0.01). No correlation was found between ΔHt, ΔWt, serum TRAcP 5b, BAP activity and types of AEDs.
  
  
  
  Growth velocity was significantly decreased in epileptic children after 1 year of VPA and/or OXC treatment. The effect of VPA and/or OXC therapy on dysregulation of bone metabolism might play a crucial role in physical growth.
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.|Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan.
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.|Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, No.699, Section 1, Zhongqi Road, Wuqi Township, Taichung, 435, Taiwan.
authors.forename: Hueng-Chuen
authors.initials: HC
authors.lastname: Fan
authors.affiliation: Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan.|Division of Hematology/Oncology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, No.291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.252, Wu Hsing Street, Taipei, 110, Taiwan.
authors.forename: Tsu-Yi
authors.initials: TY
authors.lastname: Chao
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.
authors.forename: Der-Ming
authors.initials: DM
authors.lastname: Chu
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.
authors.forename: Chi-Chieh
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan. pedneuchen@hotmail.com.
authors.forename: Shyi-Jou
authors.initials: SJ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D016723:Bone Remodeling / Q000187:drug effects*; D002220:Carbamazepine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006128:Growth / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D000078330:Oxcarbazepine; D012189:Retrospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D000078330:Oxcarbazepine
keywords: Antiepileptic drugs; Bone metabolism; Bone-specific alkaline phosphatase; Growth velocity; Tartrate-resistant acid phosphatase 5b