Hubungan Pemberian Obat Antiepilepsi dengan Vitamin D pada Penderita Epilepsi

Abstract

Background. Epilepsy is a common neurological disorder of childhood requiring long term of antiepileptic drugs that has been associated with low level of vitamin D and high prevalence of vitamin D deficiency. The aim of the study to analyze the association of antiepileptic drugs (AED) with vitamin D status in childhood epilepsy. Methods. A cross sectional study was conducted from February to April 2019 at pediatric neurology clinic Haji Adam Malik hospital Medan. One hundred and two epileptic children taking antiepileptic drug were enrolled consecutively. All cases who met inclusion criteria, underwent test for serum 25(OH)D that were categorized as normal (≥30 ng/ml) and abnormal (<30 ng/ml). Antiepileptic drugs were categorized based on enzyme inducer, polytherapy combination and monotherapy. Results. From 102 patients, 77 children (75.5%) had abnormal vitamin D and 42.2% with vitamin D insufficiency. The average level of vitamin D was 24.37 ng/ml (SD 9.23). The mean of age was 9.26 years (SD 4.96), 57.8% were boy and 79.4% on monotherapy. Association between enzyme inducing vs noninducing properties, monotherapy vs polytherapy and duration of therapy with vitamin D status were non significant with p value 0.277, 0.713 and 0.728 respectively. Sodium valproate was the most common AED used in mono therapy (87.7%) and combination of sodium valproate-topiramate in polytherapy (42.9%). There were no significant association between AED as monotherapy (p=0.713) and as combination in politherapy (p=1) with vitamin D. Conclusion: There was no significant association of antiepileptic drugs with vitamin D status in epilepsy.

Latar Belakang. Epilepsi merupakan kelainan neurologi yang sering terjadi pada anak yang membutuhkan pemakaian obat antiepilepsi (OAE) jangka panjang yang berhubungan dengan rendahnya kadar vitamin D serum dan tingginya prevalensi defisiensi vitamin D. Penelitian ini bertujuan untuk menganalisis hubungan antara pemberian obat antiepilepsi dengan vitamin D pada anak penderita epilepsi. Metode. Penelitian potong lintang dilakukan dari bulan Februari sampai dengan April 2019 di poliklinik rawat jalan neurologi anak RS Haji Adam Malik Medan. Seratus dua anak penderita epilepsi diambil secara konsekutif. Semua subjek yang memenuhi kriteria inklusi, dilakukan pemeriksaan 25(OH)D serum yang terdiri atas normal (≥30 ng/ml) dan tidak normal (<30 ng/ml). Obat antiepilepsi (OAE) dinilai berdasarkan golongan penginduksi enzim, jenis terapi, lama terapi dan kombinasi politerapi dan monoterapi. Hasil. Dari 102 pasien, 77(75.5%) anak memiliki vitamin D abnormal dan 42.2% diantaranya insufisiensi vitamin D. Rerata kadar vitamin D 24.37 ng/ml (SD 9.23). Rerata usia 9.26 tahun (SD 4.96), 57.8% anak laki-laki dan 79.4% menggunakan monoterapi. Tidak terdapat hubungan bermakna antara golongan OAE penginduksi enzim vs non-penginduksi enzim, monoterapi vs politerapi dan lama terapi dengan kadar vitamin D serum dengan nilai p secara berurutan 0.227, 0.713 dan 0.728. Asam valproat adalah obat anti epilepsi yang sering digunakan pada monoterapi ((87.7%) dan kombinasi asam valproat- topiramat (42.9%) pada politerapi.Tidak terdapat hubungan bermakna antara OAEmonoterapi (p=0.713) maupun kombinasi OAE politerapi (p=1) dengan kadar vitamin D. Kesimpulan. Tidak terdapat hubungan antara pemberian obat antiepilepsi (OAE) dengan vitamin D pada penderita epilepsi.