VITAMIN D AND BONE HEALTH IN PEOPLE WITH EPILEPSY ON ANTI SEIZURE MEDICATIONS
New research highlights the need for more guidelines on bone health and vitamin D for people with epilepsy (PWE). Many factors, including anti-seizure medications (enzyme inducing: phenytoin, and eslicarbazepine and non-enzyme inducing like sodium valproate/valproic acid), intellectual disability, early onset epilepsy, reduced mobility, reduced sodium levels , can increase the risk of vitamin D deficiency and osteoporosis in this group.
Higher-risk individuals include those with intellectual or physical disabilities, developmental and epileptic encephalopathies, early-onset epilepsy, postmenopausal women, and those on multiple medications.
While regular vitamin D blood test checks are recommended for PWE, additional bone density tests DXA are advised for high-risk individuals.
For children and young adults with epilepsy, ensuring they meet the recommended daily vitamin D and Calcium through diet and/or supplements is key.
Nutritional and Lifestyle approaches may include personalised menu planning with a focus on vitamin D, vitamin K and Calcium rich foods, weight bearing exercises, appropriate sunlight exposure and targeted vitamin D supplementation in deficiency.
Current Government Vitamin D Recommendations:
People at risk of not getting enough vitamin D (through sunshine or food), all children aged 1-4, all babies up to the age of 1 (unless having more than 500mls of fortified formula feed per day) should take a daily vitamin D supplement 10ug (micrograms) or 400 IU throughout the year.
In the UK we derive the majority (80-90%) of vitamin D through exposure to ultraviolet B sunrays from sunshine and 10-20% from dietary sources, meaning some people may not get adequate amounts of vitamin D especially in autumn/winter months.
The Department of Health and Social Care classifies at risk population if they:
- Are not often outdoors (frail, housebound, reduced mobility, anxiety)
- Are in a residential setting (care home, residential school/college, respite care)
- Usually wear clothes that cover up most of the skin when outdoors
- Are of African, African-Caribbean or south Asian background who may not make enough vitamin D from sunlight
- Have a malabsorption disorder or following weight loss surgery
- Have severe liver or end-stage chronic kidney disease
- Taking certain medications (including anti-seizure medications)
- Pregnant or breastfeeding
- Have obesity
Tolerable maximum daily vitamin D intake: (do not take more than this per day to avoid vitamin D toxicity)
- Children, young people 11-17 and adults – 100ug or 4,000 IU
- Children 1-10 years – 50ug or 2,000 IU
- Infants under 12 months – 25 ug or 1,000 IU
The recommended vitamin D thresholds in respect of bone health are:
- Increased risk of vitamin D deficiency at serum hydroxyvitamin D 25(OH)D blood levels less than 25 nmol/L
- Inadequate vitamin D at serum levels of 25(OH)D 25-50 nmol/L
- Sufficient vitamin D at serum levels above 50 nmol/L
Food sources of Vitamin D:
- Red meat
- Oily fish (sockeye and chinook salmon, sardines, herring and mackerel, halibut, rainbow trout, whitefish, fish roe, sea bass, tuna, pollock)
- Egg yolks
- Maitake, chanterelle, shiitake mushrooms
- Liver
- Buttermilk
Correction of vitamin D deficiency considers the following factors:
- Medical conditions (including kidney and liver diseases)
- Prescribed medications
- The level of vitamin D deficiency
- How quickly it needs replenishing
- Age
- Supplement preferences and how it is to be delivered (by mouth or via a gastrostomy tube)
Regular checking of blood vitamin D levels is essential in an at risk population which includes children and young people with epilepsy on long-term anti-seizure medications.
Correcting a vitamin D deficiency in some adults with epilepsy has been shown to reduce seizure frequency (30%), especially bilateral tonic-clonic seizures (52%) and improve fatigue and quality of life at 12 months of vitamin D supplementation.
Please consult a Health Professional before initiating vitamin D therapy to ensure the dose is safe and appropriate and the levels of vitamin D, calcium and phosphate are monitored.
☘️Please get in touch with us for a personalised support for your child, which may include vitamin D, calcium, phosphate and sodium blood testing as well as Nutrigenomic (single nucleotide polymorphisms) vitamin D testing which may impact vitamin D metabolism.
We also inform our families about anti-seizure medications that have been found to cause low vitamin D, vitamin K and Sodium blood levels, as well as low bone mineral density.
References:
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
https://onlinelibrary.wiley.com/doi/10.1111/epi.18050
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