Children valproate

In a young child valproate-induced stupor was unusually associated with an electroencephalographic pattern of increased fast activity [356 ]. The authors speculated that this effect of valproate was related to an interaction of valproate with GABA metabolism and GABA neuronal networks. 

Eberle, A.J. (1998) Valproate and polycystic ovaries [letter] [see comments]. J Am Acad Child Adolesc Psychiatry 37 1009. 

West, S.A., Keck P.E., Jr., and McElroy, S.L. (1995) Oral loading doses in the valproate treatment of adolecents with mixed bipolar disorder. / Child Adolesc Psychopharmacol 5 225-231. 

Ambrosini, RJ. and Sheikh, R.M. (1998) Increased plasma valproate concentrations when coadministered with guanfacine. J Child Adolesc Psychopharmacol 8 143-147. 

Wesnes K, Warburton D Effects of scopolamine and nicotine on human performance. Psychopharmacology 82 147-150, 1985 West SA, Keck PE Jr, McElroy SL, et al Open trial of valproate in the treatment of adolescent mania. J Child Adolesc Psychopharmacol 4 263-267, 1994 Westenberg HGM, De Leeuw AS, Den Boer JA Serotonin reuptake blockers in OCD. Paper presented at the 18th CINP Congress, Nice, Prance, 1992... 

A 10-year-old child had status epilepticus controlled with a combination of valproate, oxcarbazepine, and 48 hours of propofol infusion in a dose of 5.5 mg/kg/ hour. After weaning from propofol, a classic ketogenic diet was instituted in an attempt to provide long-term control of the seizures. A day later status epilepticus recurred and propofol was restarted at a rate of 6-9 mg/ kg/hour to suppress seizure activity (the diet, valproate, and oxcarbazepine were also continued). Shortly thereafter, he developed the classical constellation of malignant ventricular arrhythmias, hyperlipidemia, rhabdomyolysis, lactic acidosis, and biventricular cardiac failure. He did not survive. 

Biton V, Levisohn P, Hoyler S, Vuong A, Hammer AE. Lamotrigine versus valproate monotherapy-associated weight change in adolescents with epilepsy results from a post hoc analysis of a randomized, double-blind clinical trial. J Child Neurol 2003 18 133-9. 

Bosnak M, Dikici B, Haspolat K, Dagli A, Dikici S. Do epileptic children treated with valproate have a risk of excessive weight gain J Child Neurol 2003 18 306. 

Yehya N, Saldarini CT, Koski ME, Davanzo P. Valproate-induced hyperammonemic encephalopathy. J Am Acad Child Adolesc Psychiatry 2004 43(8) 926-7. 

Coulter DL. Carnitine, valproate, and toxicity. J Child Neurol 1991 6(1) 7-14. 

Nevertheless, may wish to be cautious in administering valproate to women of child... 

John G. Transient osteosclerosis associated with sodium valproate. Dev Med Child Neurol 1981 23(2) 234-6. 

Fatal hepatitis has been reported in a child taking valproate (79). 

The authors thought that valproate-induced hepatotoxicity may have exacerbated this child s infective hepatitis. 

A child with developmental delay and epilepsy developed glycosuria about 16 months after starting to take valproic acid (90). Laboratory evaluation showed global defects in proximal tubule function, consistent with the De Toni-Debre-Fanconi syndrome. The authors reviewed the literature on this rare complication, which is reversible on valproate withdrawal. 

Hypothermia related to valproate has been reported in a child (112). There have been five previously described cases in adults or elderly patients (113). 

White JR, Santos CS. Intravenorrs valproate associated with sigrrificant hypotension in the treatment of status epilepticrrs. J Child Nerrrol 1999 14(12) 822-3. 

Ronen GM, Richards JE, Cunningham C, Secord M, Rosenbloom D. Can sodium valproate improve learning in children with epileptiform bursts but without clinical seizures Dev Med Child Neurol 2000 42(ll) 751-5. 

Syrjanen SM, Syrjanen KJ. Hyperplastic gingivitis in a child receiving sodium valproate treatment. Proc Finn Dent Soc 1979 75(5-6) 95-8. 

Fayad M, Choueiri R, Mikati M. Fatality from hepatitis A in a child taking valproate. J Child Neurol 2000 15(2) 135-6. 

Delarue A, Paut O, Guys JM, Montfort MF, Lethel V, Roquelaure B, Pelhssier JF, Sarles J, Cambouhves J. Inappropriate hver transplantation in a child with Alpers-Huttenlocher syndrome misdiagnosed as valproate-induced acute hver failure. Pediatr Transplant 2000 4(1) 67-71. 

Williams G, King J, Cunningham M, Stephan M, Kerr B, Hersh JH. Fetal valproate syndrome and autism additional evidence of an association. Dev Med Child Neurol 2001 43(3) 202-6. 

Drug administration into the middle ear, nose, or eye of a child requires special attention. Certain drugs (e.g., sodium valproate and morphine) can be administered rectally to infants who have limited access for intravenous drug administration or if oral drug administration cannot be accomplished. 

Hellings JA, Weckbaugh M, Nickel EJ, Cain SE, Zarcone JR, Reese RM, Hall S, Ermer DJ, Tsai LY, Schroeder SR, Cook EH (2005) A double-blind, placebo-controlled study of valproate for aggression in youth with pervasive developmental disorders. 1 Child Adolesc Psychopharmacol 15 682-692. 

Side effects of valproate are few. It causes thinning and curling of the hair in about 10% of patients. It is potentially hepatotoxic but this is rare. Valproate has been linked with increased risk of neural tube defects in the unborn child. Folic acid supplements are recommended as a precaution. 

Sodium valproate Methotre)Gite (high dose) Acute lymphoblastic leukaemia A child had a seizure a few hours after methotrexate. Serum valproate levels reduced by 75%. The valproate dose was increased by 50% and clonazepam added. II... 

Two isolated reports describe valproate toxicity in a woman and a child given erythromycin. Another report describes vitamin K deficiency in a child given valproate and erythromycin. 

An isolated report describes the development of raised serum valproate levels and toxicity in a child given isoniazid while taking valproate. Another report describes raised hepatic enzymes and drowsiness in a patient taking both drugs. 

Another child who had been treated with valproate for several years was prescribed isoniazid for the treatment of tuberculosis. At the same time, seizures recurred, and the valproate was stopped and primidone 750 mg daily started. Seven months later seizures persisted, and she was admitted to hospital. Liver enzyme values were normal. Valproate 300 mg daily increased to 600 mg daily was added, and within 2 days she was vomiting and drowsy. After 5 days she had increased liver enzymes and her prothrombin time had fallen, so the valproate was stopped. Valproate levels were 81 micrograms/mL. It was speculated that the CNS effects and hepatic impairment were due to an interaction between the valproate and isoniazid. ... 

Jeavons PM, Clark JE, Maheshwari MC. Treatment of generalized epilepsies of childhood and adolescence with sodium valproate ( Epilim ). Dev Med Child Neurol ( 911) 19, 9-25. 

Valproic add, a common anticonvulsant, can accumulate and induce a hyperammonemic encephalopathy, presenting as acutely impaired consciousness, focal neurologic symptoms, and increased seizure frequency. Moreover, valproate-induced hyperammonemic encephalopathy can occur more readily in the child (or adult) with carnitine deficiency or with congenital urea cycle enzymatic defects. In fact, the occult presence of a urea cycle enzymatic defect is occasionally uncovered by the development of valproate-induced encephalopathy an occult enzyme deficiency can even make its first presentation, in the absence of valproate, in the generically stressed critical care patient, young or old (Verrotti et al., 2002 Thakur et al., 2006 Summar et al., 2005). 

Skin A child who was given sodium valproate for epilepsy developed a febrile rash 4 weeks after receiving phenobarbital as well [231" ]. Laboratory testing showed a leukocytosis with eosinophilia and raised C-reactive protein and liver enzymes. Anticonvulsant hypersensitivity syndrome due to phenobarbital was suspected and phenobarbital was withdrawn, with slow full recovery. 

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