Abnormal 13C-palmitate breath test in epileptic patients treated with valproic acid.
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Although valproic acid (VPA) is efficient in treating epileptic disorders of childhood, severe a dverse effects of VPA have been reported, such as fatal hepatic dysfunction, hyperammonemia, and a Reye-like s y ndrome. Recently the suppression of fatty acid oxidation by VPA was reported in studies of rat liver homogenates and human biopsy specimen. We carried out the <SUP>13</SUP>C-palmitate breath test on patients with VPA-t reatment and found low <SUP>13</SUP>CO<SUB>2</SUB> recoveries in the expired air of them.<BR>Methods: Before administration of <SUP>13</SUP>C-palmitate, expired air was collected for basal <SUP>13</SUP>CO<SUB>2</SUB> determination.[1-<SUP>13</SUP>]-palmitate (Kor Incorp, 10 mg/kg) was given orally to the patients who had been fasting for 15-1 6 hours. After administration, breath collection was performed at one hour intervals for the 8 hour period. <SUP>13</SUP>CO<SUB>2</SUB> in the expired air was analyzed by a mass spe ctrometer (Nuclide RMS) equipped with a dualinlet. The <SUP>13</SUP>C-abundance in the sample CO<SUB>2</SUB> was expressed as a permil (%) increase from the base <SUP>13</SUP>CO<SUB>2</SUB>/<SUP>12</SUP>CO<SUB>2</SUB> o r as cumulative <SUP>13</SUP>CO<SUB>2</SUB>% dose/7 hrs. This test was performed on 8 patients treated with VPA and other a n t i c o nvulsants (VPA-treated group) and 4 patients with other anticonvulsants (no VPA-treated group). T h e y were all hospitalized (8 males and 4 females, aged from 9 to 17 yrs), and suffered from epilepsy with o r without other problems such as mental retardation and cerebral palsy. They had no evidence of liver d y s f u ction when e x a m i n e d. Results: <SUP>13</SUP>CO<SUB>2</SUB> production in no VPA-treated group revealed a maximum 2 to 3 hours after administration and then declined. VPA-treated group revealed that <SUP>13</SUP>CO<SUB>2</SUB> production stayed at maximum for 2 to 3 hours and then showed a slow decline. The cumulative <SUP>13</SUP>CO<SUB>2</SUB> recovery of no VPA-treated group was 14.4±2.3%dose/7 hours, whereas that of VPA-treated group, 6.4±4.1%(P<0.01). We interpret these results to suggest that VPA interferes with the fatty acid metabolism in vivo and 13C-fatty acid breath test may be useful to detect its adverse effects
- 一般社団法人 日本小児神経学会の論文
一般社団法人 日本小児神経学会 | 論文
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