Abstracts

Rationale: Patients who are on chronic antiepileptic drugs (AED) and/or nonambulatory are a vulnerable population for vitamin D deficiency and comprise a large portion of a general pediatric neurology outpatient clinic. In 2008, the American Academy of Pediatrics (AAP) recommended all children and adolescents receive 400 IU vitamin D or 1000 ml vitamin D fortified milk daily, with serum 25 OH vitamin D level >50 nmol/l (20 ng/mL). AAP recommendations regarding "at risk" populations were to monitor serum 25-OH vitamin D level, and if the 25-OH vitamin D level is low, measure PTH (parathyroid hormone) and bone mineral status. Because we treat a high risk population, we chose to monitor our current practice. Methods: With IRB approval, charts of 787 consecutive patients seen in the outpatient neurology clinic were reviewed between March 9 and April 22, 2011We collected data to characterize the at risk population, adequacy of vitamin D supplement, and bone health monitoring. Data collected included documentation of use of supplemental vitamin D (either an independent supplement or as part of a multivitamin), antiepileptic drugs (AED), ketogenic diet status, ambulatory status, laboratory monitoring during that visit or within the past two years, and fractures. Not all charts contained all desired information. 778 of the 787 charts contained adequate information to analyze. Results: Of the 778 patients with available information, 592 (76%) had previously been seen in our clinic. Over 50% of patients take AED, and 15% are non-ambulatory. Any form of vitamin D supplement is taken by less than 20%of the 592 recurrent patients, 318 (54%) are on at least one AED, and 89 (15%) are non-ambulatory.102 (17%) were on some form of vitamin D supplement. 46 (8%) had a vitamin D level checked in the past 2 years. 29 were on AED and non ambulatory. 20 of 29 nonambulatory patients on AED were not on vitamin D. supplements. Conclusions: The majority of at-risk pts (on AED and nonambulatory) are not receiving vitamin D supplementation or monitoring for hypovitaminosis D. This study demonstrates the need for more rigorous vitamin D supplementation and monitoring of bone health status in vulnerable populations. Neurologists may not be as aware of guidelines published by the AAP than AAN. Studies have yet to prove that intervention with the AAP guidelines will lead to decreased fracture risk. However, neurologists care for a strongly at-risk population and may be able to affect positive change for their patients through increased awareness and action concerning bone health. Our current algorithm for monitoring bone health is: 1. Measure 25(OH) vitamin D in all ongoing patients on AED > 6 months and/or nonambulatory. 2. If vitamin D is <20 ng/mL measure PTH and increase vitamin D supplement to 800 IU/day. 3. If PTH is normal recheck vitamin D level in 6 months. 4. If PTH is elevated order Dexascan and recheck vitamin D level and PTH in 3 months. A vitamin level of 20 ng/mL is probably too low. We will collect laboratrry results with our new alogitthm.