Dr Edward Kija, Tanzania
Drs. Jo Wilmshurst, South Africa

kijaDr Kija completed the study below during his paediatric neurology specialist training through the African Paediatric Fellowship Program based at Red Cross War Memorial Children’s Hospital, University of Cape Town. He collaborated with the University of Wisconsin School of Pharmacy, Madison, WI, USA for analysis of some of the more specialised bone metabolism screens. The completed work formed the thesis part of his masters in paediatric neurology.

The study reviewed the effects of antiseizure medications (ASMs) on bone metabolism of children in a sub-Saharan Africa setting. The project was a hospital based cross-sectional study in a paediatric epilepsy service with a comparison group which assessed vitamin D metabolism. Seventy-five children with epilepsy and 75 comparison group were recruited. Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD2 (p = 0.0018), vitaminD3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products. Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzyme-inducing ASMs have lower levels of Vitamin D2 and D3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.


Kija E, Gidal BE, Shapson-Coe A, Cader S, van der Watt G, Delport S, Wilmshurst JM. Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa. Seizure. 2019 Jul;69:186-192.