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Practice Patterns of Neurologists Regarding Bone and Mineral Effects of Antiepileptic Drug Therapy
Cassandra Valmadrid, MD;
Carolyn Voorhees, PhD;
Brian Litt, MD;
Christine R. Schneyer, MD
Arch Neurol. 2001;58:1369-1374.
Background Antiepileptic drug (AED) therapy has been linked to bone disease that
can be treated and prevented with calcium and vitamin D. However, because
there have been no definitive studies on this subject, many physicians might
not be aware of this association.
Objective To determine the approaches of neurologists to skeletal disorders in
patients taking AEDs.
Design A self-administered mail survey.
Participants United States board-certified or board-eligible pediatric (n = 404)
and adult (n = 624) neurologists.
Main Outcome Measures Practice patterns of neurologists regarding methods of screening for
bone disorders and recommendations for treatment and prophylaxis.
Results Few pediatric (41%) and adult (28%) neurologists routinely evaluate
AED-treated patients for bone and mineral disease. Of physicians who detect
bone disease through diagnostic testing, 40% of pediatric and 37% of adult
neurologists prescribe calcium or vitamin D, and about half (54% of pediatric
and 57% of adult neurologists) refer patients to specialists. Few neurologists
(9% of pediatric and 7% of adult neurologists) prescribe prophylactic calcium
or vitamin D for patients taking AEDs.
Conclusions There is a lack of consensus among neurologists concerning the impact
of AED therapy on bone. Because considerable evidence suggests that much of
the bone pathology caused by AED therapy can be treated or prevented by administration
of calcium and vitamin D, raising physician awareness of this problem could
significantly improve the skeletal health of AED-treated individuals.
From the Department of Medicine, Sinai Hospital of Baltimore, Baltimore,
Md (Drs Valmadrid, Voorhees, and Schneyer); the Department of Medicine (Dr
Voorhees) and the Division of Endocrinology (Dr Schneyer), The Johns Hopkins
School of Medicine, Baltimore; and the Department of Neurology, University
of Pennsylvania, Philadelphia (Dr Litt). Dr Valmadrid is now with Divine Savior
Hospital, Portage, Wis, and Dr Voorhees is now with the National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md.
Corresponding author: Christine R. Schneyer, MD, Division of Endocrinology,
Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215-5271
(e-mail: cschneye{at}lifebridgehealth.org).
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