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[The problems of valproate therapy in severely handicapped children--valproate induced hyperammonemia and
K Matsui1, H Iwamoto, N Ohtsuki
1Division of Pediatric Neurology, Kanagawa Children's Medical Center, Yokohama.
Insights
Valproate treatment in epileptic patients increases blood ammonia and lowers serum free carnitine. Carnitine supplementation effectively improved these levels, suggesting its importance for managing valproate-induced side effects.
Area of Science:
- Neurology
- Biochemistry
- Clinical Nutrition
Abstract:
Blood ammonia and serum free carnitine were measured in 49 severely handicapped epileptic patients treated with or without valproate. DL- or L-carnitine were administered to patients treated with valproate, and the effects of carnitine supplementation were evaluated. Furthermore we analyzed the relationship between serum free carnitine and nutrition. In patients treated with valproate, blood ammonia statistically increased, and serum free carnitine concentration statistically decreased. Free carnitine was low in tube-fed patients, as compared with that in oral-fed patients. Carnitine therapy was successful in improvement of hyperammonemia and hypocarnitinemia. It is concluded that hypocarnitinemia was caused not only by valproate therapy, but also by tube-feeding. Carnitine supplementation therapy is important to both hyperammonemia and hypocarnitinemia. But the long term effect of carnitine therapy remains to be studied further.