(This blog was originally posted on July 25, 2012)
A report in the July 10th 2012 issue of Neurology found that patients with
epilepsy who take antiepileptic drugs (AEDs) are at increased risk of falls and
bone fractures. Interestingly, their
fractures were not necessarily related to falls due to a seizure episode. Advanced
age was a risk, compounded by AED-associated dizziness and unsteady gaits.
Fractures commonly involved spine, clavicle and ankles. Women on AEDs had a
higher incidence of falls compared with nonusers of AEDs (1).
Most epilepsy patients in the study were
unaware of these increased risks.
The AEDs with significant negative
effect on bone health include phenytoin (Dilantin), primidone (Mysoline) and
Phenobarbital. The data on valproate (Depakote) and carbamazepine (Tegretol)
are not as clear. No definite data are yet available on the newer AEDs (2)
(3). Bone density diminishes as duration on AEDs
and the number of AEDs increases.
In light of these findings, patients
should continue to take prescribed AEDs, increase physical activity in safe
environments and take Vitamin D and calcium supplements as recommended by their
treating physicians.
1. Ahmad BS, Hill, et
al. Falls and fractures in patients chronically treated with antiepileptic
drugs. Neurology 2012; 79: 145-151.
2. Gross RA, Gidal BE, et al. Antiseizure drugs and reduced bone density.
Neurology 2004; 62: no 11 E24-E25.
3. Beerhorst K, Schouwenaars FM, et al. Epilepsy: fractures and the
role of cumulative antiepileptic drug load. Acta Neurol Scand EPub 2011 Mar 21.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David
Geffen School of Medicine at UCLA. Conner’s
Little “Dings” is his first novel.
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