This was a prospective observational study of 122 affected children from Turkey ages 3-14 with epilepsy, cerebral palsy, and cerebral palsy and epilepsy and 30 controls. They looked at nutritional status, blood work and dexa scores of the lumbar spine. They found abnormal/low bone mineral density to be very common in children with cerebral palsy (with or without epilepsy, 50 and 39.5%) and related to the severity and immobility, compared to children with epilepsy only (3.7%).  They conclude that abnormal bone mineral density is a common problem in patients with cerebral palsy as well as cerebral palsy and epilepsy, but they did not find a relationship between bone mineral density, vitamin D levels or AED treatment.

I am glad to see more data coming out about bone health in this population, although I have some concerns about this study.
One is that in the epilepsy only category, most children only took one drug (43/54) which is not typical of my practice and is a relatively high functioning population. Their definition of vitamin D deficiency is not the one typically used (<12ng/dl for deficiency while in our practice we use <20ng/dl) and their population was homogenously vitamin D deficient or insufficient making it hard to examine the whether vitamin D levels were associated with bone mineral density. So the takeaway is that nonambulatory children with CP have low bone density and the size of this effect is much more impressive than possible smaller effect of AEDs on reducing bone mineral density either directly or by AED’s association with lower vitamin d levels.

Kelly Fradin, MD
Complex Care, Children’s Hospital at Montefiore

Tosun A et al. Bone mineral density and vitamin D status in children with epilepsy, cerebral palsy, and cerebral palsy with epilepsy. Childs Nerv Syst. 2017 Jan; 33(1):153-158. PMID: 27757568