الفهرس 
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Abstract
Epilepsy is one of the commonest neurological disorder, with a prevalence of 6–8/1000 people in developed countries (WHO,2010)
Epileptic seizures were defined according to ILAE classification system as: An ictal event believed to represent a unique
pathophysiologic mechanism and anatomic substrate. This is a
diagnostic entity with etiologic, therapeutic, and prognostic
implications.( Engel, ,2001).
The global burden of epilepsy (including epilepsy and status epilepticus) is determined by estimating the number of productive life years lost due to disability or premature death resulting from the disease (known as disability-adjusted life years, or
DALYs). Mathers, Lopez and Murray,2001 estimate the DALYs lost annually due to epilepsy as 6 223 000 worldwide. Although epilepsy is a largely treatable brain disorder and relatively cheap medication is available, between 60% and 98% of individuals with this disorder in developing countries receive no treatment.
Patients with epilepsy whose seizures do not successfully respond to AED therapy are considered to have drug-resistant epilepsy. This condition is also referred to as intractable, medically refractory, or pharmacoresistant epilepsy. As many as 20 to 40 % of patients with epilepsy are likely to have refractory epilepsy. This result in substantial deleterious effects on individual health and quality of life and a heavy (Kwan et al., 2011). prevalence of drug-resistant epilepsy are underestimated and no certain rates have been identified worldwide.
No global consensus definition for intractable epilepsy is well-recognized.the definition chosen in this study is what is known as ,the Connecticut definition, according to Berg and Kelly,2006,” failure of two appropriate AEDs and the occurrence of an average of one seizure per month for ≥ 18 months and no more than 3 months seizure freedom during that time”.
The current work aimed to determine the prevalence of vitamin D deficiency in patients with pharmacoresistant epilepsy in Ain Shams University Hospitals. As to our knowledge, there is no available data about the prevalence of vitamin D deficiency in patients with epilepsy in Egypt.
Patients attending outpatient clinics, inpatient in department of neurology were asked to participate in the study.
Six months were included in the study ,the total number of patients included in the study were 70; 30 patients with intractable epilepsy,20 patients with controlled epilepsy , 20 healthy control group. the age of the patients ranged from (18 to 56) with mean age of 28.28 years.
Data related to the diagnosis of epilepsy and intractable epilepsy were collected. That included; age of onset, seizure type, seizure semiology , seizure frequency ,duration of treatment, current anti-epileptic drug received, previous history of traumas or fractures, previous occurrence of status epileptics , screening neurological examination, electroencephalography and brain imaging of the patients were documented.
Blood samples were collected from the patients after their consent,the samples were allowed to clot for 20-30 minutes then centrifugation is done for 30 minutes , serum samples weres stored at -20 C. Using human 25hydroxyvitamin D kit assay that measures serum 25-OH-D by antigen antibody enzyme reaction , and measured through spectrophotometrically. The concentration of vitamin D in the samples calculated with refrenc to the standard curve using optical densities of the samples.
The main result of this study was 26 patients (86%) of patients with refractory epilepsy and 9 patients (45% )of patients with controlled epilepsy were found to have vitamin D deficiency with levels below 20 ng/ml, compared with those of control group, 11 patient (55%) were vitamin D deficient. Of those patients with refractory epilepsy lower vitamin D levels was associated with polytherapy of AED compared to single AED used in patients with controlled epilepsy.
In our study ,there was no association found between vitamin D status and age of the patients,age of onset of epilepsy , epilepsy type, family history of epilepsy , and past history of traumas or fractures.
Another finding of this study is seizure frequency is inversely related to vitamin D levels, and longer duration of treatment with antiepileptic associated with lower levels of vitamin D.
Finally, to our knowledge that was the first study to point out to vitamin D deficiency in adults with intractable epilepsy, whereas, all other studies held carried on children and adolescents.