Effect of valproic acid treatment on body composition, leptin and the soluble leptin receptor in epileptic children

Summary: Purpose: The aim of the study was to determine the influence of valproic acid (VPA) treatment on leptin, the soluble leptin receptor (sOB-R), the sOB-R/leptin ratio, body composition and insulin resistance in epileptic children. Methods: A cross-sectional cohort study was conducted at the Medical University Innsbruck, Austria. Children >6 years with idiopathic epilepsy and antiepileptic drug therapy since at least six months were eligible. Leptin concentration, the sOB-R, the sOB-R/leptin ratio, body composition and glucose homeostasis were determined. Results: 87 children (median [range] age 12.8 years [6.0–18.6]) were on treatment with VPA, 55 (12.3 years [6.4–18.3]) on other AEDs, comprising the non-VPA group. VPA-treated children had higher leptin concentrations, body-mass-index standard-deviation score (SDS), body fat (each p <0.001), serum insulin concentrations (p =0.014) and homeostasis model assessment (HOMA) index (p =0.009), as well as a lower sOB-R/leptin ratio (p <0.001) when compared to the non-VPA group. Overweight VPA-treated children showed lower sOB-R concentrations and a lower sOB-R/leptin ratio (each p <0.001) as well as higher body fat and leptin levels (each p <0.001) compared to lean VPA-treated children. Conclusion: VPA monotherapy was associated with higher body weight, body fat and serum leptin concentrations as well as impaired glucose homeostasis. Low sOB-R concentrations and a low sOB-R/leptin ratio in overweight VPA-treated patients might contribute to disturbances in glucose homeostasis and to the development of the metabolic syndrome in these children later in life. [Copyright &y& Elsevier]