Alexia Prassouli

Early and persistent increase in serum lipoprotein (a) concentrations in epileptic children treated with carbamazepine and sodium valproate monotherapy

PURPOSE The aim of this study was to investigate by a prospective, self-controlled method, whether treatment with carbamazepine (CBZ) and sodium valproate (VPA) monotherapy may alter serum lipoprotein (a) [Lp(a)] concentrations in epileptic children. METHODS Serum Lp(a) concentrations have been determined in 18 epileptic children before and at 6, 12 and 24 months of treatment with CBZ monotherapy and in 30 epileptic children before and at 6, 12 and 24 months of treatment with VPA monotherapy. Serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoproteins A-I and B concentrations and serum concentrations of biochemical markers of liver and renal function were also measured in the study participants. RESULTS Serum Lp(a) concentrations were significantly increased at 6, 12 and 24 months of CBZ and VPA monotherapy. There were no significant correlations between serum Lp(a) and serum lipids, lipoproteins, apolipoproteins, concentrations of biochemical markers of liver and renal function or antiepileptic-drugs concentrations. CONCLUSIONS Children who receive CBZ or VPA monotherapy may have significant and persistent increase in serum lipoprotein (a) concentrations, occuring early in the course of therapy. It may be useful to measure serum Lp(a) concentrations routinely in epileptic children taking these antiepileptic drugs, especially in those that are already at higher atherosclerotic risk.

Transient decrease in serum albumin concentrations in epileptic children treated with sodium valproate monotherapy

Objective: Hypoalbuminemia has been reported in patients with severe disability and epilepsy and in patients with epilepsy treated with short-term sodium valproate (VPA) therapy; however, serum albumin concentrations have not previously been determined in otherwise healthy patients with epilepsy and receiving long-term VPA monotherapy. Methods: Serum albumin concentrations were determined in 26 ambulatory children with epilepsy before and at 6, 12, and 24 months of VPA monotherapy. Serum total protein concentrations and serum concentrations of other biochemical markers of liver and renal function such as alanine aminotransferase, aspartate aminotransferase, &ggr;-glutamyltransferase, and creatinine concentration were also measured in the study participants before and at 6, 12, and 24 months of treatment. Results: Serum albumin concentrations were reduced at 6 months of treatment (P = 0.007). Serum alanine aminotransferase concentrations were significantly increased at 6 (P = 0.034) and 12 months of treatment (P = 0.046), whereas serum aspartate aminotransferase concentrations were significantly increased at 6 (P = 0.002) and 12 months of treatment (P = 0.002). There were no significant correlations between serum albumin and the other parameters at 6 months of treatment. Conclusions: Ambulatory children who receive VPA monotherapy may have early but transient decrease in serum albumin concentrations. Further studies are needed to address this issue and to determine the possible clinical implications and the mechanisms involved in VPA-mediated decrease in serum albumin concentrations. Abbreviations: VPA, sodium valproate, ALT, alanine aminotransferase, AST, aspartate aminotransferase, &ggr;-GT, &ggr;-glutamyltransferase

EVALUATION OF LEARNING DIFFICULTIES IN EPILEPTIC CHILDREN WITH IDIOPATHIC GENERALIZED EPILEPSY AND WELL-CONTROLLED SEIZURES

INTRODUCTION: Children with symptomatic epilepsy have more learning difficulties (LDs) than those with idiopathic or cryptogenic epilepsies. However, there is little information on the prevalence of LDs in well-defined pediatric epileptic populations. OBJECTIVE: Our goal was to evaluate LDs in epileptic children. METHODS: We evaluated LDs in 37 epileptic children (18 boys and 19 girls; mean age: 8.29 ± 1.00 years) who had idiopathic generalized epilepsy (IGE) and were being treated with sodium-valproate monotherapy (22 with generalized tonic-clonic seizures and 15 with absence epilepsy). The mean duration of epilepsy and treatment was 3.48 ± 1.88 and 2.96 ± 1.80 years, respectively. All children attended mainstream schools, and their seizures were well controlled (without seizures for at least 6 months). We used the Athina Test for the Diagnosis of Learning Difficulties, a test that is partly based on the Illinois Test of Psycholinguistic Abilities, standardized in healthy Greek children. RESULTS: Children with IGE performed significantly poorer in all subtests except the auditory closure subtest (Table 1). No significant difference was found between the 2 subgroups. A negative correlation was found between disease duration and the score in auditory memory (r = −0.368; P = .025). CONCLUSIONS: Our results suggest an increased risk of LDs in children with IGE and well-controlled seizures. Early detection of the cognitive impact of IGE and subsequent intervention are needed to prevent educational underachievement. TABLE 1. Athina Test for the Diagnosis of LDs Subjects With Inadequate Performance, % P Children With IGE Healthy Children Auditory memory 64.9 9.0 .000 Visual memory 43.2 9.0 .000 Grammatic closure 43.2 9.0 .000 Auditory closure 16.2 9.0 .125 Graphophonological awareness 32.4 9.0 .000 Visual-motor coordination 43.2 25.0 .010