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Risk of excessive weight gain in epileptic children treated with valproate
G P Novak1, J Maytal, A Alshansky
1Division of Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. gpn325@aol.com
Insights
Valproate treatment in children is linked to increased weight gain and body mass index, particularly in girls, who also experienced a decrease in height Z-score. Initial weight status predicted future weight changes.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Valproate is a widely used antiepileptic drug in children.
- Excessive weight gain is a potential adverse effect of valproate therapy.
- Identifying risk factors for weight gain is crucial for patient management.
Purpose of the Study:
- To identify factors associated with excessive weight gain in children treated with valproate.
- To analyze changes in body mass index (BMI) and height Z-scores during valproate therapy.
Main Methods:
- Retrospective analysis of 55 children treated with valproate.
- Weight and height measurements recorded pre-treatment and at follow-up.
- Calculation of BMI (kg/m²) and Z-scores for weight and height for age.
Main Results:
- Significant increase in BMI and weight Z-score observed in the study cohort.
- Height Z-score significantly decreased in girls but remained stable in boys.
- Initial BMI and weight Z-score were significant predictors of subsequent weight changes.
Conclusions:
- Valproate therapy is associated with increased BMI and weight gain in children.
- Female sex and longer duration of follow-up are linked to decreased height Z-score.
- Pre-treatment weight status is a key factor influencing weight changes during valproate treatment.
Abstract:
We sought to identify factors associated with excessive weight gain in children treated with valproate, excluding patients fed by gastrostomy or treated with medications known to affect appetite (eg, stimulants). Weight and height were recorded before treatment and at the time of follow-up; a measure of adiposity, body mass index, was computed and expressed in kg/m2, and weight and height for age were converted to Z-score. Putative risk factors included sex, age at start of treatment, monotherapy at start of treatment, duration of follow-up, mental retardation, seizure type (generalized or partial), etiology (idiopathic or cryptogenic versus remote symptomatic), and dose of valproate. Fifty-five children (30 girls, 25 boys), ranging in age at the start of therapy from 1.8 to 16.9 years were followed for 8.6 to 33.8 months. Forty-three patients had primarily generalized seizures, 34 had idiopathic or cryptogenic epilepsy (including 30 with generalized idiopathic epilepsy), and 18 had mental retardation. Valproate was the first antiepileptic drug for 21 patients, and 43 were on monotherapy at the time of follow-up. Height Z-score decreased significantly in girls but was stable in boys. There was a significant increase in body mass index and in weight Z-score. Body mass index was greater than the 90th percentile for age in 14 patients at the start of treatment and in 20 patients at follow-up. Decrease in height Z-score was significantly correlated with female sex and duration of follow-up. Changes in weight Z-score and body mass index were significantly correlated with initial weight Z-score and initial body mass index, respectively, but not with age at start of therapy, duration of follow-up, sex, seizure type, etiology, dose of valproate, or monotherapy.