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

SummaryPurposeThe 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.MethodsA 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.Results87 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.ConclusionVPA 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.