Evaluate the effects of long-term valproic acid treatment on metabolic profiles in newly diagnosed or untreated female epileptic patients: A prospective study

- Valproic acid therapy should be used very cautionally in female epileptic patients who have higher BMI before therapy.
- VPA therapy induces hypoadiponectinemia which correlates negatively with insulin resistance.
- VPA-induced weight gain seems to be appetite-related rather than metabolic.

PurposeExcessive weight gain associated with sodium valproate (VPA) may predispose patients with epilepsy to other health problems such as insulin resistance. We prospectively evaluated the long-term impact of VPA monotherapy compared with lamotrigine (LTG) monotherapy on anthropometric and metabolic parameters in women with epilepsy. Our primary objective is to understand the underlying mechanism responsible for VPA-induced obesity.MethodsSixty-six female patients with newly diagnosed or untreated epilepsy were included in the study. Thirty-four patients with VPA and thirty-two patients with LTG were treated for a period of one year in our center. Anthropometric and clinical data were collected at 5 time points: before, at 6th week, 3rd month, 6th month, 9th month and 12th month (last visit). Biochemical and hormonal data were collected 2 time points: before and last visit.ResultsSubjects in the VPA group had significantly higher body weight than LTG-treated subjects (64.88 ± 3.25 vs. 58.28 ± 2.43, P < 0.001). HOMA-IR level was significantly increased (2.76 vs. 1.35, P < 0.05), and adiponectin levels were significantly lower in the VPA group (3.46 vs. 6.22, P < 0.05). Triglycerides levels were significantly increased (118 vs. 96, P < 0.05), and HDL-C levels were significantly lower in the VPA group. Both the VPA-treated group and the LTG-treated group showed no significant difference in term of total cholesterol, LDL-C, fasting blood glucose and serum leptin levels.ConclusionsBased on the findings of this study, we proposed that VPA induced hypoadiponectinemia which correlates significantly with insulin resistance. These two factors may be responsible for weight gain, possible by stimulating appetite. Valproic acid appears to be use cautionally in obese females with epilepsy.