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You are the paediatric registrar at an epilepsy clinic. A mother of a 9-year-old patient with childhood absence epilepsy asks if he should be taking vitamin D. He is currently prescribed sodium valproate. You wonder if you should prescribe vitamin D supplementation alongside his antiepileptic medication.
Structured clinical question
In children with a clinical diagnosis of epilepsy on antiepileptic drugs (AED) (population), is there evidence to suggest that they should receive supplemental vitamin D (intervention) to improve their bone health (outcome)?
We searched OVID MEDLINE in June 2020 with the keywords (Child OR Paediatrics OR Pediatrics) AND (Vitamin D OR Vitamin D Deficiency OR Cholecalciferol OR Calcitriol) AND (Anti-Epileptic Drug OR Anti-Epileptic Medication OR Anti-Convulsant Drug).
The search was limited to articles in English from the year 2000. Sixty-five articles were identified.
Twenty articles were included after initial scrutiny and four were selected for full-text review. One further study was identified on review of article references. These were graded according to the Oxford level of evidence (table 1).1
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Vitamin D deficiency is common worldwide. Vitamin D is protective for musculoskeletal health. Children treated with AED are known to have problems with bone metabolism and bone mineral density (BMD) loss. Enzyme-inducing AEDs (phenytoin, carbamazepine, primidone and phenytoin) increase vitamin D metabolism due to induction of cytochrome P450. Newer, non-enzyme-inducing antiepileptic drugs (NEIAEDs) can affect bone metabolism in a variety of ways, including stimulation of osteoclast activity, direct action on bone cells, parathyroid hormone resistance, inhibition of calcitonin secretion …
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Contributors MS, NC, TB and AT conceived the clinical question. MS carried out the literature search. MS, PM, TB and AT drafted the manuscript. MS, PM and AT drafted the summary of articles included. MS and PM decided on papers for inclusion. All reviewed the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.