Effect of anticonvulsant drug sodium valproate on hepatic profile in children

Abstract

Background: Sodium valproate is one of the most common antiepileptic medications used in clinical practice. The period of treatment is commonly associated with benign alternation of the liver enzymes due to drug metabolism. Evaluation of asymptomatic enzymatic changes could be challenging to the expert clinician and may expose patients to unnecessary procedures or expenses. Thus, this article aims to focus on the frequency of liver enzyme abnormalities among epileptic children. Materials & Methods: The current prospective observational study was conducted on children with seizure disorder attending Pediatric OPD of Rajendra Institute of Medical Sciences, Ranchi. Period of study was extended from February 2014 to October 2015. Patient randomly selected from outdoor of department of Pediatric having seizure disorder. All children aged 2 years to 10 years, of either sex having partial or generalized seizure and who have recently started either phenytoin, valproate or carbamazapine were selected for study. Routine investigations like complete blood count, peripheral blood smear, CRP, blood glucose, CT Brain/Spine, EEG and hepatic profile like aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), alkaline phosphatase, total serum bilirubin (direct & indirect), prothombin time or international normalized ratio (INR), serum albumin and Australia antigen (HbsAg) on valproate therapy were done. Results: The present study revealed that, the patients treated with valproate have shown significant increase mean ALP level after 1 year of treatment as p values were 0.03, 0.02 and 0.03 respectively. The patients treated with valproate have shown no significant increase mean SGPT and SGOT level after 1 year of treatment. It was also found that there was no significant increase in mean TSB and mean PT. Also there was no significant decrease in mean serum albumin. Conclusion: The significant increase was seen in mean ALP level these increase is probably due to enzyme-inducing or enzyme-inhibiting properties of drugs. SGPT, SGOT levels increases from the initial value but not to significant level. The study recommends obtaining baseline liver enzymes tests prior to commencement of treatment. However, the benefit of routine screening in asymptomatic patients has not proved. Further controlled studies with a large sample size are warranted.