Abstracts

In treating epilepsy in the inner city, there are numerous barriers to prevention, diagnosis and treatment of metabolic bone disease. Anti-epileptic drugs (AEDs) lead to a loss of bone density of up to 35% compared to normals. Supplementation with a multivitamin/mineral (MVI), folate and calcium (w/ vitamin D) is critical for bone health, especially for persons with epilepsy. Bone density screening by DEXA scan is required for diagnosis. The goal of this study is to elucidate these barriers. Standard of practice in our clinic is to address bone health and nutrition with all patients and to communicate treatment issues to referring primary care physicians(PCP). We screened 101 consecutive patients (women n = 56, men n = 45) seen in our clinic over 4 months to determine the most frequent barriers to osteoporosis prevention. Data on each subject included: age, gender, seizure type, neurologic co-morbidities, years on AEDs, supplementation patterns and DEXA screening results. A problem list was compiled. This was an adult epilepsy population: Mean age: 44 years (SD = 14.8, range 19 to 78), Average length of AED exposure: 21 years (SD = 16, range 0.25 to 54).
Common barriers for prevention were compliance-related: of 87 subjects prescribed supplements, 47 patients took a MVI and 34 took calcium. In this population, the cost of over the counter (OTC) medications and supplements is a limitation. Some had difficulty remembering to take supplements.
DEXA scan was recommended for 47 of 101 subjects; 28 of 47 obtained DEXA. 23 subjects had abnormal results(osteopenia n = 13, osteoporosis n = 8, kyphosis n = 2). One of the most common barriers to screening was related to managed care; 55% of subjects had HMOs requiring referrals for DEXA scans. This process is time consuming. Physical/mental impairment preventing DEXA scan was also a barrier. This retrospective review identified important issues in nutrition and epilepsy. It has been established that there is significant metabolic bone loss due to AEDs. The addition of supplements to a patient[rsquo]s program is relatively easy. However, issues of cost and compliance are common barriers. Potential solutions include: coverage of OTC medications by insurance, a cost/value summary of supplements and nutritional counseling of dietary sources of calcium to aid decision making.
[ldquo]Compliance[rdquo] is a term that tends to blame the patient. The idea of partnership in medicine can foster a sense of personal health responsibility in the patient. Despite routine communications to PCPs regarding need for screening/supplementation for bone health, in the epilepsy population, the recognition of its importance is still overlooked. Health behaviors related to lifestyle are struggles that require individual, community and nationwide approaches.