Total amylase, pancreatic amylase and lipase levels in children with epilepsy on valproic acid

Abstract

Acute pancreatitis associated with valproic acid (VPA) treatment is reported in literature. Amylases however are not specifically originated in the pancreas. Other organs, such as salivary glands, may be involved in causing higher serum activity. Thus, we aimed to investigate whether serum total amylase and particularly its pancreatic isoenzyme and lipase levels are altered in the course of treatment with VPA in children with epilepsy. The study was conducted on 45 children with epilepsy on VPA monotherapy. Trough serum VPA, serum total amylase, lipase, and pancreatic amylase levels were evaluated in the patients and results were compared to a matched control group. Though all patients were asymptomatic for acute pancreatitis, serum total amylase levels were elevated in 40%. Patients with increased levels of total amylase did not differ from the rest of patients regarding the characteristics of epilepsy syndrome or the degree of seizure control. Nevertheless, there was significant positive correlation between total amylase and VPA trough serum levels. Five patients had simultaneous elevation of total amylase, pancreatic isoenzyme and lipase levels, though in none of them reaching three folds the upper limit. They had no symptoms suggestive of acute or intermittent pancreatitis and their ultrasonic examination was normal. Follow up showed normalization of their serum levels. In conclusion, our results demonstrate the limited specificity of total amylase level as a marker for pancreatic injury. Whenever there is suspicion, a workup including pancreatic isoenzymes is advisable. The implication of asymptomatic elevation of pancreatic isoenzymes needs to be further investigated.