Therapie mit Valproinsäure bei Kindern Bedeutung der Laboratoriumsbefunde und des therapeutischen Drug-Monitoring

Background. The scope of laboratory diagnostic measures necessary in the case of children receiving anti-epileptic valproate treatment has been controversially discussed. The aim of the present study was to evaluate possible interconnections between valproate treatment,changes to the clinico-chemical parameters as well as the blood level of valproic acid and valproate metabolites in children. Methods and Patients. 69 children and adolescents (ages:6 months to 16 years) were treated regularly with valproic acid (mono- or polytherapy).Valproic acid and valproate metabolites were determined in serum using capillary gas chromatography mass spectrometry. Results. No clinically relevant interconnections between the forms of therapy (mono- or polytherapy),the valproic acid dosage,the measured valproic acid and metabolite blood levels, on the one hand, and the clinico-chemical parameters,on the other, could be determined. Significant correlations only occurred between alanine-amino-transferase and valproic acid as well as some metabolites (3-keto,4-keto and (E)-3-en-valproate). Hepatotoxic side-effects were not seen even in these children. Conclusions. It can be concluded from our results that determination of clinico-chemical and haematological parameters is only indicated with the corresponding clinical symptoms even in the case of children over 3 years (just as in adults).This reduces the burden on these children. Further investigations into extended therapeutic drug-monitoring should be considered for children under three years which also includes some valproate metabolites.