Clinical analysis of valproate-associated low fibrinogen in 13 children with epilepsy

Abstract

Objective To explore the characteristics and effects of valproate (VPA) on the low level of fibrinogen (FIB) in children with epilepsy. Methods The clinical data of children with epilepsy who hospitalized in Beijing Children′s Hospital Epilepsy Diagnosis and Treatment Center from June 2014 to June 2015 were collected. The children′s serum FIB levels were found declined after administration of valproate. The children′s age, gender, diagnosis, use of valproate (route of administration, dosage, blood concentration, and time of medication), the FIB level before and after of administration of valproate, treatment and prognosis were recorded and analyzed retrospectively. The children were followed up by telephone. Results A total of 13 children were enrolled into the study. Their age ranged from five months to nine years and 10 months, the median age was 29 months. Eight of the 13 cases were infants (62%). The dosage of valproate was 140 to 1 080 mg/d, the median dose was 280 mg/d. The serum concentration of valproate was 22.55-81.32 mg/L, and the median concentration was 39.80 mg/L. The children′s FIB levels decreased 6-91 days after administration of valproate (the median time 13 days). The children′s FIB level before and after administration of valproate were 2.17-3.23 g/L ( the median level 2.36 g/L) and 1.20-1.93 g/L (the median level 1.60 g/L), respectively. The difference was statistically significant (P=0.01). There were no hemorrhage in any of the 13 children during the hospital stay and the follow-up period after discharge (11 months to 1 year and 6 months ). There were no adjustment of therapeutic regimen of valproate in 13 children. Conclusions The children, especially infants with epilepsy may develop FIB decrease to below the reference value after taking normative dose of valproate. Decrease of FIB usually do not lead to hemorrhage. It is suggested that children′ FIB should be monitored in the early stage of taking valproate. Key words: Valproate; Epilepsy children; Fibrinogen