Effect of Levetiracetam Monotherapy on Serum Calcium, Vitamin D and Seizure Control in Children with Epilepsy: A Longitudinal Observational Study

Abstract

Aims: To evaluate the effect of levetiracetam monotherapy on serum calcium and vitamin D levels in children with epilepsy, and to assess seizure control and associated side effects. Study Design: Longitudinal observational study. Place and Duration of Study: Department of Paediatrics, Dr. B. C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata; from December,2022 to May,2024. Methodology: 79 children (44 males, 35 females; 6 months–12 years) with epilepsy on levetiracetam monotherapy were enrolled. Baseline and 6-month follow-up of clinical and laboratory evaluations was done including serum calcium and vitamin D. Seizure control and side effects were documented. Data were analysed using paired t-test/Wilcoxon signed rank test with significance at P <0.05. Results: Generalized seizures were most common (81%), followed by focal (13.9%) and unclassified (5.1%). After 6 months, 64.5% were seizure-free, with mean seizure duration decreasing from 8.92 ± 6.63 to 7.51 ± 5.73 minutes (P = .01). Serum calcium declined from 9.18 ± 0.61 to 9.01 ± 0.63 mg/dl (P =.02), and vitamin D from 26.04 ± 6.76 to 25.09 ± 6.34 ng/ml (P =.04); values largely remained within normal limits despite statistical significance. Vitamin D deficiency was present in 19% at baseline and 20.3% at follow-up, while insufficiency rose from 39.2% to 48.1%. Neuropsychiatric side effects occurred in 44.3% (notably behavioural abnormalities 16.5%, anxiety 10.1%), and musculoskeletal symptoms included bone pain (16.5%) and cramps (10.1%). No significant association was found between vitamin D levels and side effects. Conclusion: Levetiracetam monotherapy is effective for seizure control in children but is associated with small, significant decline in serum calcium and vitamin D over 6 months, demanding attention of clinicians on bone heath of epileptic children with levetiracetam monotherapy. Limitation: Short follow-up, lack of bone mineral density assessment, dietary and sun exposure data is limitation of this study.