Growth hormone response to diazepam, clonidine and glucagon in patients with epilepsy

Comorbidity of childhood epilepsy

Epilepsy in children is occasionally associated with variable comorbidities although the frequency of such comorbidity is often difficult to determine. They can be divided into three categories: neurological, psychological, and physical comorbidities. The goal of the present review is to discuss the reported comorbidities of epilepsy in children. The possible mechanisms and associated risk factors-including the effect of seizure frequency and seizure control, types of epilepsy, age of seizure onset, duration of illness, and the possible detrimental effect of antiepileptic drugs-will be described.

Growth hormone levels in children and adolescents with epilepsy

BACKGROUND

Patients with epilepsy often complain of symptoms that may be caused by disturbances in their hormonal balance. Disturbances in physical growth has been previously described. The aim of this study was to evaluate the effect of epilepsy and/or anti-epileptic drugs on the physical growth of patients with idiopathic epilepsy, as well as on the growth hormone (GH) and insulin growth factor-1 (IGF-1) status in those patients.

METHODS

The study comprised 40 children and adolescents with idiopathic epilepsy on either valproate or carbamazepine. Anthropometric measurements [occipitofrontal circumference, weight, height, body mass index, span, and midarm circumference] were taken. Serum levels of GH before and after provocation with L-dopa and of IGF-1 were assessed. Results were compared to a matched control group.

RESULTS

The height measurements were reduced in patients with epilepsy compared to the controls group. Though weight values were not significantly different, the body mass indices of the patients were significantly higher than controls, especially in patients on valproate therapy. Basal GH levels showed no significantly variation between patients and controls. However, post provocation GH and IGF-1 levels were significantly lower in patients. The type of epilepsy, disease duration, and the degree of seizure control had no significant effect on the studied parameters. In conclusion, physical growth seems to be affected in patients with epilepsy. This may be due to hormonal imbalance as evident by reduced post provocation GH levels and IGF-1 levels in the included group of patients.

Chronic administration of sodium valproic acid slows pubertal maturation in inbred DBA/2J mice: skeletal, histological, and endocrinological evidence

Sodium valproic acid (VPA) has been reported to occasionally delay pubertal maturation in children. In the current study, we sought to establish a valid animal model with which to further investigate the neuroendocrinological sequelae of VPA administration. Male and female DBA/2J mice were weaned at 2 weeks of age and administered either VPA (17-20 mg/kg/day) or control solution via drinking water. Animals were weighed and sacrificed via decapitation at 4, 6, or 8 weeks of age. Testes and ovaries were prepared for histological analyses. In addition, the length of the left humerus bone from each animal was obtained as an index of skeletal growth, and trunk blood was assayed for circulating follicle-stimulating hormone (FSH) and prolactin (PRL). For males, testicular weights of the animals receiving VPA were significantly lower than those of control animals at all three sampling ages. No between-group differences were found for body weight at any sampling age, and yet the rate of skeletal maturation (as indexed by humerus length) was decreased significantly for the VPA-treated males at all three sampling periods. Additionally, while hormone levels did not consistently differ, histological analyses of the gonadal tissue demonstrated significantly decreased rats of spermatogenesis at all sampling points for VPA-treated animals. For females, chronic VPA administration led to a significant reduction in uterine weight at the 4 and 6 week sampling periods, and yet by 8 weeks of age the uterine weights for the two groups did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Pubertal arrest associated with valproic acid therapy

Valproic acid has previously been demonstrated to decrease the secretion of multiple pituitary hormones; however, clinical symptoms associated with decreased hormone secretion have not been described. A girl is reported with complex partial seizures who was treated with valproic acid from age 10 years, 7 months to 12 years, 1 month and during this time had an arrest of both growth and secondary sexual development. Two months after discontinuing valproic acid she had resumption of both pubertal growth and maturation. A prospective controlled study is needed to determine more precisely the effects of valproic acid on growth and development.