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NEUROLOGY

Body Mass Index and Serum Lipid Changes During Treatment with Valproic Acid in Children with Epilepsy

Clinical Researcher, Pediatric Neurology Section, Department of Pediatrics, Obstetrics, Gynecology and Reproductive Medicine, University of Siena, Siena, Italy

Rosa Mostardini, MD

Clinical Assistant, "Santa Maria alle Scotte" Hospital, Azienda Ospedaliera Universitaria Senese, Siena

Barbara Piccini, MD

Clinical Assistant, Department of Pediatrics, Obstetrics, Gynecology and Reproductive Medicine, University of Siena

Paolo Balestri, MD

Assistant Professor, Head of Pediatric Section, Head of Pediatric Neurology Section, Pediatric Neurology Section, Department of Pediatrics, University of Siena

Reprints: Dr. Grosso, Pediatric Neurology Section, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Viale M. Bracci, Le Scotte, 53100 Siena, Italy, fax 0577 586143, grosso{at}unisi.it

BACKGROUND: Valproic acid is the drug of choice for a wide variety of epileptic seizures and syndromes because of its broad spectrum of activity and because, in most patients, it is well tolerated. Although weight gain is a well-known adverse effect of valproic acid therapy, only a few studies have addressed weight gain associated with it in children aged 2–8 years.

OBJECTIVE: To evaluate valproic acid–associated changes in the body mass index (BMI) z-scores and to assess changes in serum triglyceride, cholesterol, and fasting glucose levels in young children receiving valproic acid treatment.

METHODS: Eighty-seven patients (39 females, 48 males) receiving valproic acid therapy for at least 3 months were included in the retrospective longitudinal study. Mean ± SD age at initiation of therapy was 4.8 ± 0.8 years. Changes in BMI z-scores as well as serum triglyceride, total cholesterol, and fasting glucose levels were evaluated as continuous variables and analyzed by longitudinal methods for all patients.

RESULTS: The average change from baseline in BMI z-scores was 0.80 (p = 0.001) at 3.1 years of follow-up. No significant change in triglyceride, cholesterol, and serum fasting glucose levels was observed over the same period. The percentage of overweight children at baseline was 6.9% and rose to 16% by the final visit (p = 0.081).

CONCLUSIONS: Valproic acid–associated weight gain may occur in young children. However, only 16% of patients were categorized as overweight at the end of the study; this percentage overlaps the percentage of overweight healthy young Italian children. The BMI z-scores significantly increased during the first 16 months of therapy, then appeared to level off. These observations may influence clinical practice and decision-making regarding suspending the drug due to weight gain in children in whom seizure control has been achieved.

Key Words: antiepileptic drugs, epilepsy, pediatrics, valproic acid, weight gain

Published Online, December 9, 2008. www.theannals.com, DOI 10.1345/aph.1L414