Abstracts

Valproic acid (VPA) is an excellent antiepileptic drug both against generalized and partial seizures. A number of severe adverse effects have been associated to VPA-treatment. 238 patients have died related to VPA worldwide, due to hepatotoxicity, pancreatitis and very rarely to bleeding complications. We conducted a nation-wide survey asking members of the German Section of ILAE to report all patients with severe side effects related to VPA within the last 10 years. Pancreatitis: 46 unpublished patients were reported, all with a reversible outcome and lipase [gt] 500 U/l. This number approaches the number of all published patients in the literature, which shows that pancreatitis is by far under-reported but generally has a good outcome.
Bleeding complications: Pathological findings of coagulation parameters, especially of v.Willebrand-factor, Ristocitin-Co-factor and Factor XIII occurred frequently, but clinical complications were rare and reversible. (Only two patients had died directly due to impaired coagulation before 1994).
Hepatotoxcity: The pattern of liver complications changed very much during the past 10 years. By far most episodes of severe hepatotoxicity were reversible, VPA was withdrawn early and i.v.carnitine was substituted in most patients. An equal number of adult patients and children died related to VPA during the past 10 years in Germany: 4 children and 4 adults, most with polytherapy and additional risk factors. Severe complications related to VPA continue to occur, but the increasing awareness of the problem greatly improved the chance for a reversible outcome. Considering the increasing number of patients treated with VPA and the decreasing number of fatalities, the frequency of the latter can be estimated to be below 1: 100000 overall. VPA remains an indispensable drug of first choice for both pediatric and adult patients.