Skip to main content
SpringerLink
Log in

Carnitine Deficiency in Chinese Children with Epilepsy on Valproate Monotherapy

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To explore the incidence and independent risk-factors of secondary carnitine deficiency in Chinese children with epilepsy on valproate monotherapy.

Methods

The free carnitine and acylcarnitines levels in 299 children with epilepsy on valproate monotherapy between June 2014 and September 2015 were compared with age- and sex-matched 299 healthy controls.

Results

Children with valproate monotherapy had lower free carnitine levels [23.86 (10.60) μmol/L] than the controls [36.37 (9.37) μmol/L] (P<0.01). Most acylcarnitines were significantly lower in children with valproate monotherapy than controls. 63 children (21.1%) with epilepsy had carnitine deficiency; 54 were asymptomatic. Female gender (OR 2.1), high alanine aminotransferase levels (OR 1.0) and long duration of VPA treatment (1-12 mo) (OR 1.9) were independent risk factors for secondary carnitine deficiency induced by VPA.

Conclusions

Carnitine deficiency with valproate is more likely in females, those with transaminitis, and those receiving the drug for 1–12 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nakashima H, Oniki K, Nishimura M, Ogusu N, Shimomasuda M, Ono T, et al. Determination of the optimal concentration of valproic acid in patients with epilepsy: A population pharmacokinetic-pharmacodynamic analysis. PLoS One. 2015; 10:e0141266.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Silva MF, Aires CC, Luis PB, Ruiter JP, IJlst L, Duran M, et al. Valproic acid metabolism and its effects on mitochondrial fatty acid oxidation: a review. J Inherit Metab Dis. 2008;31:205–16.

    Article  PubMed  CAS  Google Scholar 

  3. Lheureux PE, Hantson P. Carnitine in the treatment of valproic acid-induced toxicity. Clin Toxicol (Phila). 2009;47:101–11.

    Article  PubMed  CAS  Google Scholar 

  4. El-Hattab AW, Scaglia F. Disorders of carnitine biosynthesis and transport. Mol Genet Metab. 2015;116:107–12.

    Article  PubMed  CAS  Google Scholar 

  5. De Vivo DC, Bohan TP, Coulter DL, Dreifuss FE, Greenwood RS, Nordli DR Jr, et al. L-carnitine supplementation in childhood epilepsy: current perspectives. Epilepsia. 1998;39:1216–25.

    Article  PubMed  Google Scholar 

  6. Hirose S, Mitsudome A, Yasumoto S, Ogawa A, Muta Y, Tomoda Y. Valproate therapy does not deplete carnitine levels in otherwise healthy children. Pediatrics. 1998;101:E9.

    Article  PubMed  CAS  Google Scholar 

  7. Fung EL, Tang NL, Ho CS, Lam CW, Fok TF. Carnitine level in Chinese epileptic patients taking sodium valproate. Pediatr Neurol. 2003;28:24–7.

    Article  PubMed  Google Scholar 

  8. Cansu A, Serdaroglu A, Biberoglu G, Tumer L, Hirfanoglu TL, Ezgu FS, et al. Analysis of acylcarnitine levels by tandem mass spectrometry in epileptic children receiving valproate and oxcarbazepine. Epileptic Disord. 2011;13:394–400.

    PubMed  Google Scholar 

  9. Fukuda M, Kawabe M, Takehara M, Iwano S, Kuwabara K, Kikuchi C, et al. Carnitine deficiency: Risk factors and incidence in children with epilepsy. Brain Dev. 2015;37:790–6.

    Article  PubMed  Google Scholar 

  10. Beghi E, Bizzi A, Codegoni AM, Trevisan D, Torri W. Valproate, carnitine metabolism, and biochemical indicators of liver function. Collaborative Group for the Study of Epilepsy. Epilepsia. 1990;31:346–52.

    CAS  Google Scholar 

  11. Moreno FA, Macey H, Schreiber B. Carnitine levels in valproic acid-treated psychiatric patients: a cross-sectional study. J Clin Psychiatry. 2005;66:555–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kutlu O, Cansu A, Karagüzel E, Gürgen SG, Koç O, Gür M, et al. Effect of valproic acid treatment on penile structure in prepubertal rats. Epilepsy Res. 2012;99:306–11.

    Article  PubMed  CAS  Google Scholar 

  13. Surendradoss J, Chang TK, Abbott FS. Assessment of the role of in situ generated (E)-2, 4-diene-valproic acid in the toxicity of valproic acid and (E)-2-ene-valproic acid in sandwich-cultured rat hepatocytes. Toxicol Appl Pharmacol. 2012;264:413–22.

    Article  PubMed  CAS  Google Scholar 

  14. Nakamura M, Nagamine T. The effect of carnitine supplementation on hyperammonemia and carnitine deficiency treated with valproic acid in a psychiatric setting. Innov Clin Neurosci. 2015;12:18–24.

    PubMed  PubMed Central  Google Scholar 

  15. Mock CM, Schwetschenau KH. Levocarnitine for valproic-acid-induced hyperammonemic encephalopathy. Am J Health Syst Pharm. 2012;69:35–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Qiliang Li & Wenqi Song

  2. Department of Neurology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

    Hong Jin

Authors
  1. Qiliang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenqi Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenqi Song.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Q., Song, W. & Jin, H. Carnitine Deficiency in Chinese Children with Epilepsy on Valproate Monotherapy. Indian Pediatr 55, 222–224 (2018). https://doi.org/10.1007/s13312-018-1322-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-018-1322-4

Keywords

Search

Navigation