Hubungan Lamanya Pemakaian Asam Valproat terhadap Perubahan Parameter Metabolisme Tulang pada Penderita Epilepsi Idiopatik

Abstract

Background. Long-term use of anti epileptic drugs such as valproic, could have side effects to the bone metabolisme and density which finally can cause rachitis, osteomalacia and fracture. Recent studies found that long-term used of valproic acid can cause hipocalcemia, hipophosphatemia and the increased of alkaline phosphatase serum in epileptic children. Objective. To determine the effect of long-term use of valproic acid to the calcium, phosphate and alkaline phosphatase serum levels in epileptic children. Methods. A cross sectional study was conducted at Pediatric Neurology Outpatient Clinic, Haji Adam Malik Hospital Medan, from March until Mei 2015. Twenty epileptic children who were treated with valproic acid were enrolled. Calcium, phosphor and alkaline phosphatase serum levels were performed to all subjects. Data analyzed using Spearman correlation test with 95% CI and P<0.05. Results. Mean age of the subject was 7.21 yeas old, and the mean time of using valproic acid was 11.9 month. Bone profile measurement showed that mean level of calcium was 8.9 mg/dL, phosphor was 4.4 mg/dL and serum alkaline phosphatase was 171.65 IU/L. Spearman correlation test showed that long-term use of valproic acid had a strong enough correlation with level of phosphor ( r = -0.52 P = 0.01), and no correlation with level of calcium (r= -0.42, P= 0.05) and alkaline phosphatase serum (r = -0.01, P= 0.93 ). Conclusion. Long-term used of valproic acid had a strong enough correlation with the phosphor serum level but had no correlation with calcium and alkaline phosphatase serum levels

Latarbelakang. Penggunaan obat anti epilepsi jangka panjang, salah satunya asam valproat yang luas dipergunakan saat ini, bisa menimbulkan efek samping terhadap metabolisme tulang dan kepadatan tulang sehingga bisa terjadi rakhitis, osteomalasia dan fraktur tulang. Penelitian sebelumnya menemukan bahwa pengobatan jangka panjang dengan asam valproat dapat menimbulkan hipokalsemia, hipofosfatemia dan peningkatan serum alkali fosfatase. TujuanUntuk mengetahui efek lamanya pemberian asam valproat terhadap kalsium, fosfor dan serum alkali fosfatase pada anak penderita epilepsi. MetodePenelitian cross sectional dilakukan di poliklinik Divisi Neurologi Anak dan ruang rawat jalan anak RSUP. H. Adam Malik Medan pada bulan Maret sampai Mei 2015. Sebanyak 20 orang anak penderita epilepsi yang mendapat pengobatan dengan asam valproat ikut dalam penelitian. Seluruh subyek dilakukan peneriksaan profil tulang (kalsium, fosfor dan alkali fosfatase). Data dianalisa dengan uji korelasi Spearman dengan tingkat kepercayaan 95% dan kemaknaan p<0.05. Hasil Dari pemeriksaan ditemukan rerata usia subyek adalah 7.21 tahun dan rerata lama pemakaian asam valproat 11.9 bulan. Hasil pemeriksaan profil tulang menunjukkan rerata serum kalsium 8.9 mg/dL, rerata fosfor serum 4.4 mg/dL dan rerata serum alkali fosfatase serum 171.65 IU/L. Dari uji korelasi Spearman ditemukan lama pemakaian asam valproat berkorelasi sedang (r=0.52) dan bermakna dengan fosfor serum (p=0.01), namun tidak memiliki hubungan yang bermakna dengan kalsium dan serum alkali fosfatase (p>0.05). KesimpulanLama pemakaian asam valproat memiliki hubungan yang bermakna dengan kadar fosfor serum namun tidak memiliki hubungan dengan kadar kalsium dan alkali fosfatase.