Bone and Hormonal Health in Premenopausal Women with Epilepsy

描述（由申请人提供）：根据美国疾病控制中心的数据，骨折是美国致残的主要原因，在癫痫患者中增加了2到4倍。虽然不完全了解，但与骨骼健康不良相关的因素已成为癫痫骨折风险增加的重要组成部分。因此，候选人提出了一个多学科的教育计划和研究项目，以获得适用于癫痫，骨骼和激素健康领域的专业知识。该教育项目将包括哥伦比亚大学梅尔曼公共卫生学院的临床研究设计、实施和分析的正式课程，以及内分泌部门医学教授伊丽莎白·谢恩博士在骨代谢方面的结构化纵向指导。此外，她将作为一名初级研究员参加Frank博士的Gilliam's NINDS赞助的K24项目，题为“癫痫及相关疾病的临床研究”。

DESCRIPTION (provided by applicant): Based on Centers for Disease Control data, fractures are a leading cause of disability in the United States, and are increased two to four fold in persons with epilepsy. Although incompletely understood, factors related to poor bone health have emerged as important components of the increased risk for fracture in epilepsy. Therefore, the candidate proposes a multidisciplinary educational program and research project to gain expertise in areas applicable to epilepsy, and bone and hormonal health. The educational program will include formal coursework in clinical study design, implementation, and analysis at the Columbia University Mailman School of Public Health and also a structured longitudinal preceptorship in bone metabolism with Dr. Elizabeth Shane, Professor of Medicine in the Endocrine Division. In addition, she will participate as a junior investigator in Dr. Frank's Gilliam's NINDS sponsored K24 program entitled, "Clinical Research in Epilepsy and Related Disorders. The specific aims of the research proposal are to determine the separate and combined contribution of seizure activity and treatment with cytochrome P450 enzyme-inducing antiepileptic drugs, on 1) measurements of bone mineral density and rates of bone loss; 2) bone remodeling activity and bone microarchitecture by both measurement of biochemical markers of bone turnover and quantitative histomorphometry; 3) the vitamin D-parathyroid hormone system and evaluate its relationship to bone mineral density and rates of bone loss; 4) reproductive hormones and their relationship to bone mineral density and microarchitecture, bone remodeling and rates of bone loss. We will test our hypotheses through a prospective 3X2 factorial design study of subjects with well controlled and active epilepsy on antiepileptic drug treatment. The design and analysis will differentiate the contributions of recurrent seizures and cytochrome P450 hepatic enzyme inducing antiepileptic drugs. We anticipate that the results of our study will provide a rationale basis for targets in research and improved management of consequences of epilepsy and its treatment. Public Health Statement: Epilepsy affects 1% of the population. Persons with epilepsy treated with antiepileptic drugs are at risk for adverse effects on bone health, most importantly fracture. By defining and understanding the risk that epilepsy and antiepileptic drugs have on bone health, we will significantly impact those persons with epilepsy treated with antiepileptic drugs.