1. Acute hepatic injury in four children with Dravet syndrome: Valproic acid, topiramate or acetaminophen?
- Author
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Berten Ceulemans, Boudewijn Gunning, Joost Nicolai, Piet L. J. M. Leroy, and Johan S.H. Vles
- Subjects
Male ,Topiramate ,Liver toxicity ,Developmental Disabilities ,Clinical Neurology ,Nerve Tissue Proteins ,Fructose ,Pharmacology ,Sodium Channels ,Epilepsy ,Liver Function Tests ,Dravet syndrome ,Influenza, Human ,Stiripentol ,medicine ,Humans ,Acetaminophen ,Prothrombin time ,Valproate ,Valproic Acid ,medicine.diagnostic_test ,business.industry ,organic chemicals ,Myoclonic Epilepsy, Juvenile ,digestive, oral, and skin physiology ,Infant ,Syndrome ,General Medicine ,Carbamazepine ,Analgesics, Non-Narcotic ,medicine.disease ,Enzymes ,NAV1.1 Voltage-Gated Sodium Channel ,stomatognathic diseases ,Neurology ,Anticonvulsants ,Drug Therapy, Combination ,Female ,lipids (amino acids, peptides, and proteins) ,Neurology (clinical) ,Chemical and Drug Induced Liver Injury ,business ,medicine.drug - Abstract
SummaryWe describe four children with Dravet syndrome treated with the combination of valproic acid (VPA) and topiramate (TPM) who developed transient liver toxicity. The time-interval between fever, administration of acetaminophen, epileptic status and liver enzyme disturbances in our four cases suggests that accumulation of toxic acetaminophen-metabolites is possibly responsible for liver toxicity. If acetaminophen and its metabolites cause those liver problems in children treated with the combination of VPA and TPM, the advice to use acetaminophen for treating fever in children using this combination, should be changed. Only future clinical observations and research can solve this clinical dilemma.
- Published
- 2008
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