Valproic Acid: A Different View

PEDIATRICS ◽  
1982 ◽  
Vol 70 (2) ◽  
pp. 331-331
Author(s):  
J. Kiffin Penry
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
American Academy ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Published Data ◽  
American Academy Of Pediatrics

The Committee on Drugs of the American Academy of Pediatrics has prepared a statement on the benefits and risks of the antiepileptic drug valproic acid; this statement appears in this issue of Pediatrics (70:316, 1982). This report is extensive and objective in its review of published data on valproic acid, and is of great value to practicing pediatricians for that reason. However, the review fails to place vaiproic acid in perspective with other marketed antiepileptic drugs, which in many instances have equally serious side effects.

Definition and Incidence of Adverse Events

2018 ◽  
pp. 136-140
Author(s):  
David Fagin
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Supportive Care ◽  
American Academy ◽  
Procedural Sedation ◽  
Patient Harm ◽  
Timely Manner ◽  
Psychological Conditions ◽  
American Academy Of Pediatrics ◽  
National Organizations

To perform effective and safe procedural sedation, one must be knowledgeable about the adverse events that can occur with the administration of various sedatives and analgesics. Adverse events (sometimes thought of as complications of care) are often predictable if the sedationist properly assesses the patient’s physiologic and psychological conditions and understands the side effects of the medications administered and the procedural conditions that may exacerbate risk. With such preparation, the sedationist can monitor for the event and can either prevent it or provide supportive care in a timely manner. The American Academy of Pediatrics and other national organizations have developed guidelines for caring for patients requiring procedural sedation with the intent of informing sedationists of the risks involved in sedation care and the skills and equipment needed to ameliorate or prevent patient harm. Adverse events can be classified as minor, moderate, and major.

Plasma homocysteine and aminothiol levels in idiopathic epilepsy patients receiving antiepileptic drugs

2019 ◽  
Vol 44 (5) ◽  
pp. 661-666
Author(s):  
Dilber Çoban Ramazan ◽  
Ülker Anadol ◽  
A. Destina Yalçın ◽  
A. Süha Yalçın
Keyword(s):  
Valproic Acid ◽  
Folic Acid ◽  
Vitamin B12 ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Serum Vitamin ◽  
Idiopathic Epilepsy ◽  
Serum Folate ◽  
Significant Difference ◽  
Epileptic Patients

Abstract Objective Homocysteine is a sulfur containing amino acid that is formed during methionine metabolism. Patients under long-term antiepileptic drug treatment often have hyperhomocysteinemia. These patients have low levels of serum folate, vitamin B12 and vitamin B6, all of which are associated with homocysteine metabolism. We have investigated the effects of valproic acid and new generation antiepileptic drugs (lamotrigine and levetiracetam) on plasma levels of homocysteine and aminothiols as well as serum vitamin B12 and folic acid. Materials and methods Forty-seven idiopathic epileptic patients on antiepileptic drugs were compared with 38 age-matched healthy controls. Commercial immunoassay methods were used for vitamin B12 and folic acid analyses. Homocysteine, cysteine, cysteinylglycine and glutathione levels were determined by high performance liquid chromatography. Results There was no significant difference in patient and control values in terms of vitamin B12, folic acid and homocysteine. Valproic acid and lamotrigine seemed to effect aminothiol redox status. Glutathione levels of epileptic patients receiving valproic acid and lamotrigine were higher than controls. Conclusion Our results suggest that redox homeostasis may be impaired and glutathione synthesis increased in response to the oxidative stress caused by antiepileptic drug use.

scholarly journals Patterns and prognostic markers for treatment response in generalized epilepsies

Neurology ◽  
2020 ◽  
Vol 95 (18) ◽  
pp. e2519-e2528 ◽  
Author(s):  
Joanna Gesche ◽  
Helle Hjalgrim ◽  
Guido Rubboli ◽  
Christoph P. Beier
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Treatment Response ◽  
Antiepileptic Drugs ◽  
Seizure Control ◽  
Retention Rate ◽  
High Rate ◽  
Seizure Freedom ◽  
Inverse Association ◽  
Acceptable Side

ObjectiveTo determine the pattern of treatment response in patients with idiopathic generalized epilepsy (IGE) and whether routinely assessed clinical and neurophysiological parameters allow predicting response to lamotrigine, levetiracetam, or valproic acid.MethodsIn 328 adult patients with IGE, demographic data, imaging, EEG data, current and prior antiepileptic treatment, treatment outcome, and side effects were analyzed from the patients' medical files and patient interviews.ResultsSeizure freedom with acceptable side effects at the first attempt was achieved in 61 (18.6%) patients. One hundred four (31.7%) patients tried ≥3 antiepileptic drugs before achieving seizure control at the last follow-up. Lamotrigine, levetiracetam, and valproic acid showed differential response rates (39.8% vs 47.5% vs 71.1%) that were most pronounced in patients with juvenile myoclonic epilepsy. The risk of having side effects was higher with valproic acid (23.7%) than with lamotrigine (10.4%) or levetiracetam (20.4%) treatment, contributing to the low retention rate of valproic acid (53.7%). Treatment resistance was associated with established risk factors. Multivariate analyses aiming at identifying clinical indicators for response to specific drugs did not reveal putative biomarkers when corrected for drug resistance.ConclusionDespite a high rate of seizure control, the chance of achieving seizure control and acceptable side effects at first attempt was low due to an inverse association of effectiveness and side effects of the 3 most commonly used drugs. Routinely assessed clinical parameters were not indicative for response to specific drugs.Classification of evidenceThis study provides Class II evidence that for patients with IGE, various clinical factors do not predict a response to specific antiepileptic drugs.

Letters to the Editor

PEDIATRICS ◽  
1973 ◽  
Vol 52 (5) ◽  
pp. 754-754
Author(s):  
Keyword(s):  
Side Effects ◽  
American Academy ◽  
Medical Literature ◽  
Letters To The Editor ◽  
Anticonvulsant Agents ◽  
American Academy Of Pediatrics

The Committee offers the following comments: The Committee on Drugs of the American Academy of Pediatrics appreciates the communication from Drs. Livingston, Berman, and Pauli concerning the use of amphetamines in the management of epilepsy. The Committee has carefully considered the two indications which Drs. Livingston et al. have raised in their letter. A thorough search of the medical literature by the Committee has failed to reveal any data documenting the efficacy of amphetamines in counteracting the side effects of usual anticonvulsant agents.

scholarly journals Cross Sensitivity of Skin Rashes with Antiepileptic Drugs

1997 ◽  
Vol 24 (3) ◽  
pp. 245-249 ◽  
Keyword(s):  
Valproic Acid ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Outpatient Clinic ◽  
The Other ◽  
Cross Sensitivity ◽  
Sensitivity Rate ◽  
The Cross

ABSTRACT:Objective:Skin rashes are a well known complication of antiepileptic drug (AED) treatment. It has also been recognized that some patients will develop rashes from multiple AEDs (cross sensitivity). There are very few studies that have attempted to determine the frequency of cross sensitivity among AEDs.Methods:Charts of all patients attending an epilepsy outpatient clinic were reviewed to determine AED exposure and the occurrence of a rash from AEDs.Results:633 patients had 1,875 exposures to 14 AEDs. Rashes occurred from carbamazepine (N = 27), phenytoin ( N = 21), phenobarbital (N = 5) and lamotrigine (N = 1). A rash from 2 or more AEDs occurred in 14 patients and involved predominantly carbamazepine and phenytoin. Among the patients exposed to both phenytoin and carbamazepine 10/17 (58%) of patients with a rash from phenytoin also had a rash from carbamazepine; conversely 10/25 (40%) patients with a carbamazepine rash also had a rash from phenytoin. 4/5 patients with a phenobarbital rash were sensitive to carbamazepine and/or phenytoin. Amongst the other most commonly used AEDs no rashes occurred from valproic acid or clobazam.Conclusions:The cross sensitivity rate for rashes involving carbamazepine and phenytoin is 40-58%. If a rash develops from either of these AEDs, valproate or clobazam are safe alternatives.

scholarly journals Pharmacogenetics of antiepileptic drugs: A brief review

2016 ◽  
Vol 6 (1) ◽  
pp. 28-34 ◽  
Author(s):  
D. Parker ◽  
E. J. Sanders ◽  
K. J. Burghardt
Keyword(s):  
Side Effects ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
International Organizations ◽  
Drug Response ◽  
Genetic Variations ◽  
Clinical Settings ◽  
Patient Response ◽  
Drug Labeling ◽  
Pharmacogenetic Research

Abstract The goal of pharmacogenetic research is to assist clinicians in predicting patient response to medications when genetic variations are identified. The pharmacogenetic variation of antiepileptic drug response and side effects has yielded findings that have been included in drug labeling and guidelines. The goal of this review is to provide a brief overview of the pharmacogenetic research on antiepileptic drugs. It will focus on findings that have been included in drug labeling, guidelines, and candidate pharmacogenetic variation. Overall, several genes have been included in guidelines by national and international organizations; however, much work is needed to implement and evaluate their use in clinical settings.

Valproic acid: a new antiepileptic drug with potential side effects of dental concern

1979 ◽  
Vol 99 (6) ◽  
pp. 983-987
Author(s):  
Thomas M. Hassell ◽  
Gilbert C. White ◽  
Leonard G. Jewson ◽  
Leon C. Peele
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Antiepileptic Drug

Comments on Nutrition Committee Statement

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 673-673
Author(s):  
John Silverio
Keyword(s):  
Birth Weight ◽  
American Academy ◽  
Preterm Infants ◽  
Published Data ◽  
Low Birth Weight Infants ◽  
Water Requirements ◽  
Premature Babies ◽  
American Academy Of Pediatrics ◽  
Nutritional Needs ◽  
Nutrition Committee

This is a comment on the statement on the nutritional needs of low-birth-weight infants, made by the Committee on Nutrition of the American Academy of Pediatrics (Pediatrics 60:519, October 1977). 1. In the section on water requirements (p. 519), the document states that "preterm infants excrete sodium well." This statement is backed tip by two references.1,2 Although the two quoted references are reliable, it is also true that other published data have shown that premature babies do not excrete sodium well, with subsequent retention of water.3

Half-Dose Immunization for Diphtheria, Tetanus, Pertussis: Response of Preterm Infants

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 471-476
Author(s):  
July Bembaum ◽  
Andrea Daft ◽  
Joel Samuelson ◽  
Richard A. Polin
Keyword(s):  
Immune Response ◽  
Side Effects ◽  
American Academy ◽  
Preterm Infants ◽  
Time Intervals ◽  
Full Dose ◽  
American Academy Of Pediatrics ◽  
Half Dose ◽  
Fourth Dose ◽  
Dtp Vaccine

The American Academy of Pediatrics currently recommends administering full-dose diphtheria, tetanus, pertussis, (DTP) vaccine to preterm infants, beginning at 2 months' chronologic age. Many physicians, however, continue to administer DTP vaccine at a reduced dosage in an attempt to lessen side effects. This study was designed to quantitate the immune response of 20 preterm infants immunized with half-dose DTP vaccine and to determine the nature and extent of side effects. Control subjects were 25 preterm infants immunized with full-dose vaccine. Although 96% of infants who received a full dose were able to mount a serologic response to pertussis after a second dose of DTP, 45% of infants who received a half dose were unable to mount a similar immune response to pertussis even after a third dose of DTP and required a full-dose (fourth dose of DTP) vaccine to better ensure protection. Serologic responses to diphtheria and tetanus were similar in the two groups. The incidence of side effects in preterm infants receiving both full-dose and half-dose DTP was less than that seen in a full-term population. Thus, the physician caring for the preterm infant should adhere to the American Academy of Pediatrics' recommendation for the immunization of preterm infants and offer full-dose DTP vaccine at the routine time intervals of 2, 4, 6, and 15 or 18 months' chronologic age to ensure adequate protection.

scholarly journals Pharmacokinetic Interactions of Antiepileptic Drugs

1984 ◽  
Vol 11 (2) ◽  
pp. 247-251 ◽  
Author(s):  
Penny S. Albright ◽  
J. Bruni
Keyword(s):  
Valproic Acid ◽  
Drug Interactions ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Plasma Levels ◽  
Multiple Drug ◽  
Concurrent Disorders ◽  
Epileptic Patients ◽  
Clinically Significant ◽  
Multiple Drug Therapy

ABSTRACT:The problem of antiepileptic drug interactions is significant in that many epileptic patients are treated with multiple drug therapy. Moreover, patients may also be receiving additional medication for other concurrent disorders. Most drug interactions are pharmacokinetic, involving changes in absorption, protein binding, metabolism, or excretion. As a result, plasma levels of the antiepileptic drug may decrease leading to exacerbation of seizures. Alternatively, plasma levels may rise resulting in toxic side effects. Similar changes may also occur with drugs given for other disorders. In this paper, possible mechanisms of drug interactions are discussed. This is followed by a description of clinically significant interactions involving phenytoin, carbamazepine, barbiturates, valproic acid, benzodiazepines, and succinimides. Potentially serious drug interactions may be minimized by using as few medications as possible and by regularly monitoring plasma levels of antiepileptic drugs.

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