The Association Between Antiepileptic Drugs and Bone Health

抗癲癇藥物與骨骼健康的關聯性

范洪春(Hueng-Chuen Fan) ； 張祐剛(Yu-Kang Chang) ； 陳玉珍(Yu-Chen Chen) ； 陳怡妤(Yi-Yu Chen) ； 繳君慧(Chun-Hui Chiao) ； 遲景上(Ching-Shiang Chi)

《童綜合醫學雜誌》 13卷2期 (2019/12) Pp. 64-74

https://doi.org/10.3966/207135922019121302002

摘要

Bone and calcium metabolism disorders are emerging as major issues in the treatment of pediatric patients with epilepsy because children in this stage experience rapid growth, weight gain, and skeletal and genital maturation under the influence of several hormones. There is a relatively complex and multifaceted relationship among epilepsy, antiepileptic drugs (AEDs), and bone and calcium homeostasis. Whether classical AEDs (e.g., benzodiazepines, carbamazepine, phenytoin, phenobarbital, and valproic acid) or newer AEDs (e.g., levetiracetam, oxcarbazepine lamotrigine, topiramate, gabapentin, and vigabatrin) can adversely affect bone health remain unclear. Cytochrome P450 induction, which is one of the properties of AEDs, can cause vitamin D deficiency and lead to lower calcium levels, lower bone mass, increased fracture risk, and altered bone turnover. However, controversial results have been obtained because of the wide spectrum of the antiseizure activities of these AEDs with several different mechanisms of action, which are discussed in this review.

關鍵字

Bone ； calcium metabolism ； epilepsy ； antiepileptic drugs ； cytochrome P450

並列摘要

骨骼和鈣代謝疾患是治療兒童癲癇患者的主要問題之一，因為在此階段中，兒童會受到多種荷爾蒙的作用，而有快速生長，體重增加，骨骼和生殖器的成熟。然而在癲癇，抗癲癇藥物，骨骼和鈣平衡之間的關係是相對複雜和多方面。典型的抗癲癇藥物（例如benzodiazepines, carbamazepine, phenytoin, phenobarbital, 和valproic acid）或更新的抗癲癇藥物（例如Levetiracetam, oxcarbazepine lamotrigine, topiramate,gabapentin, 和vigabatrin）已被報導會對骨骼健康產生不利影響。抗癲癇藥物的另一特性，是細胞色素P450（CYP-450）同功酶的誘導劑，可能導致維生素D的缺乏，鈣的濃度降低，骨量減少，骨折風險增加和改變骨代謝。由於這些抗癲癇藥物有廣泛的抗癲癇作用，涵蓋多種不同的作用機制，造成爭議的結果，這些都將在本文中討論。

並列關鍵字

骨骼 ； 鈣代謝 ； 癲癇 ； a抗癲癇藥物 ； 細胞色素P450