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British Journal of General Practice

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Editorials

Bone health in adults with epilepsy and intellectual disability

Robert Winterhalder and Rohit Shankar
British Journal of General Practice 2022; 72 (716): 100-101. DOI: https://doi.org/10.3399/bjgp22X718553
Robert Winterhalder
Bromley, Kent, Learning Disability Epilepsy Service, Oxleas NHS Foundation Trust.
Roles: Consultant Psychiatrist
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Rohit Shankar
Cornwall Partnership NHS Foundation Trust, Truro; Cornwall Intellectual Disability Equitable Research (CIDER), Peninsula School of Medicine, University of Plymouth, Plymouth.
Roles: Professor in Neuropsychiatry and Consultant Neuropsychiatrist
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Epilepsy is more prevalent in individuals with intellectual disability (ID) compared to the general population, and this prevalence increases with increasing severity of ID. Epilepsy affects approximately 22% of people with ID, while 25% of people with epilepsy (PWE) have an ID.1 Epilepsy is associated with significantly impaired bone health including osteoporosis and bone fractures,2 while individuals with ID are at increased risk of osteopenia and osteoporosis, and vitamin D deficiency.3

BONE HEALTH AND EPILEPSY

There has been growing interest in the association between abnormalities of bone health and epilepsy in recent years. PWE who are housebound or institutionalised, avoid sunlight for cultural reasons, or have poor nutrition are at increased risk of vitamin D deficiency. This can predispose to osteopenia/osteoporosis and proximal myopathy leading to weakness and increased fall liability. Associated conditions such as cerebral palsy with inability to weight bear, reduced physical activity, or visual impairment can be contributory factors. Anti-seizure drug (ASD) side-effects like ataxia, sedation, and seizures, especially convulsive ones, can increase the risk of falls and subsequent fractures particularly in those with reduced bone mineral density (BMD).

Attention, however, has focused mainly on ASDs and their role in abnormal bone metabolism. The relationship between abnormalities of bone health and ASDs is commonly thought to be due to the enzyme-inducing properties of many ASDs leading to reduced serum vitamin D levels, but this is not the only mechanism. Sodium valproate, an enzyme inhibitor, is also associated with reduced BMD and increased risk of fractures. Other mechanisms suggested include inhibition of intestinal calcium absorption, osteoclast cell growth, cellular response to parathyroid hormone and calcitonin secretion, and direct effects on bone cells.4 Newer …

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British Journal of General Practice: 72 (716)
British Journal of General Practice
Vol. 72, Issue 716
March 2022
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Bone health in adults with epilepsy and intellectual disability
Robert Winterhalder, Rohit Shankar
British Journal of General Practice 2022; 72 (716): 100-101. DOI: 10.3399/bjgp22X718553

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Bone health in adults with epilepsy and intellectual disability
Robert Winterhalder, Rohit Shankar
British Journal of General Practice 2022; 72 (716): 100-101. DOI: 10.3399/bjgp22X718553
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    • BONE HEALTH AND EPILEPSY
    • BONE HEALTH IN PEOPLE WITH INTELLECTUAL DISABILITY
    • IMPLICATIONS FOR PRIMARY CARE
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More in this TOC Section

  • Continuity of GP care: using personal lists in general practice
  • Creating space for gut feelings in the diagnosis of cancer in primary care
  • GP workforce crisis: what can we do now?
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Print ISSN: 0960-1643
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