VALPROIC ACID IN CHILDHOOD EPILEPSY - ANTI-CONVULSIVE EFFICACY IN RELATION TO ITS PLASMA-LEVELS

  • 1 January 1980
    • journal article
    • research article
    • Vol. 18  (10) , 461-465
Abstract
Plasma levels of valproic acid were monitored for 2 yr in 90 epileptic children. From 34 patients receiving sodium valproate as monotherapy, complete seizure control could be achieved in 28 children (82%) with a mean (.+-. SD) plasma level of 65.1 .+-. 20.3 .mu.g/ml. In 6 patients (18%) seizures recurred. As their plasma levels were significantly (P = 0.008) higher (91.7 .+-. 35.2 .mu.g/ml) than in the controlled patients, their disorder might be regarded as resistant to therapy with sodium valproate. The drug seems to be effective in patients with absences, tonic-clonic seizures and partial epilepsy. The most common combination of anticonvulsants administered was valproate/phenobarbital (n = 22). In 14 children of this group (64%) seizures were completely controlled with plasma levels of 54.6 .+-. 26.5 .mu.g/ml. In the 5 uncontrolled patients (23%) valproate concentrations were lower (33.8 .+-. 28.2 .mu.g/ml, P = 0.08); 20 children were treated with more than 2 anticonvulsants. This population probably represents the most severe cases. Only 7 patients (35%) exhibited complete seizure control with valproate plasma concentrations of 63.1 .+-. 51.9 .mu.g/ml. In the uncontrolled patients the levels were slightly lower (43.8 .+-. 24.8 .mu.g/ml). Side effects were observed in 7 patients (21%) receiving sodium valproate alone. Most common effects were increase in appetite (n = 4), and gastrointestinal disturbances (n = 2). Additionally, 1 patient complained about transient hair loss and 1 felt tired. In most cases their plasma concentrations were > 70 .mu.g/ml. A therapeutic range of 40-90 .mu.g/ml is postulated.

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