1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-4-32 10.15844/pedneurbriefs-4-4-11 Seizure Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Valproate Toxicity http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 04 1990 01 08 2016 4 4 32 32 Copyright: © 1990 The Author(s) 1990 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Edema associated with long-term valproate therapy

Facial and limb edema in seven patients during long-term valproate therapy are reported from the Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, Bronx, NY.

 Valproate Therapy Fulminant Hepatic Thrombocytopenia

Facial and limb edema in seven patients during long-term valproate therapy are reported from the Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, Bronx, NY. Ages ranged from 6 to 43 years; four were 6 to 17 years. All received dosages greater than 1500 mg/day for a prolonged time and trough levels ranged from 36 to 107 mcg/ml. Four patients were receiving other medications. All had normal liver and renal function tests. Reduction in the edema occurred in four following a reduction in valproate dosage, and one resolved spontaneously. [1]

COMMENT. In a recent case report of a three year old boy from Japan a fulminant hepatic failure induced by valproate was associated with a marked increase in W-oxidation of the drug. The patient died on the seventh hospital day and autopsy findings showed acute liver necrosis with congestion and cholestasis [2]. Valproate-induced thrombocytopenia was reported in a total of 35 patients at the 42nd annual meeting of the AAN. (Delgado et al) [3]. Close monitoring of platelet counts is recommended particularly when high doses of valproate are necessary in treatment of children with epilepsy. Thrombocytopenia may develop after several years of therapy and seems to be dose related.

 Ettinger A Moshe S Shinnar S Edema associated with long-term valproate therapy Epilepsia 1990 Mar-Apr 31 2 211 213 10.1111/j.1528-1167.1990.tb06308.x 2108016 Kuhara T Inoeu Y Matsumoto M Shinka T Matsumoto I Kawahara N Markedly increased omega-oxidation of valproate in fulminant hepatic failure Epilepsia 1990 Mar-Apr 31 2 214 217 10.1111/j.1528-1167.1990.tb06309.x 2108017 Sherbany AA Rothman SJ Jayabose S Neurology 1990 April 40 Suppl I 136 137