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Parameter Mean SD Age 3.43 (years) 1.71 Age of seizure onset 9.57 (m) 5.83 Age of VPA start 16.29 (m) 4.87 Duration of VPA 14.86 (m) 15.50 VPA Dose 31.4 (mg/kg/day) 7.4 SD - Standard deviation, M - months
Patient / Clinical diagnosis EEG Brain imaging Development Microcephaly Focal discharges Normal Cognitive delay Focal epilepsy Focal discharges Lissencephaly GDD* Meningitis (HSV meningitis) Generalized epileptic discharges Atrophy GDD Focal epilepsy Focal discharges Normal Normal Focal epilepsy Focal discharges Sturge weber syndrome Mild hemiparesis Infantile spasms, congenital Muscular dystrophy Hypsarrhythmia Hydrocephalus, Muscle eye brain disease GDD Hydrocephalus Slow background Hydrocephalus and brain tumor (astrocytoma) GDD Noonan syndrome and infantile spasms Hypsarrhythmia Normal GDD Epilepsy (genetic), infantile spasms, panhypopituitarism Hypsarrhythmia brain atrophy & corpus callosum agenesis also panhypopituraism GDD Meningoencephalitis Generalized epileptic discharges Atrophy and cystic encephalomalacia Normal VP shunt hydrocephalus Generalized epileptic discharges Hydrocephalus & Chiari malformation type 2 GDD VP shunt Hydrocephalus Generalized epileptic discharges Hydrocephalus GDD Metabolic, aminoacidopathy Encephalopathy Normal Normal Down syndrome & congenital heart disease Focal epileptic discharges Enlarged ventricles Cognitive delay Focal seizures Slow background Normal Normal GM1 gangliosidosis Slow background Brain atrophy GDD Meningoencephalitis Generalized epileptic discharges Normal Normal Mitochondrial disease Encephalopathy Mitochondrial disease (leigh disease) GDD Idiopathic epilepsy Slow background Normal Normal Infantile spasms Hypsarrhythmia Hypoxic ischemic encephalopathy GDD Birth asphyxia Generalized epileptic discharges Periventricular leukomalacia GDD NCL* type 14 Generalized epileptic discharges Brain atrophy GDD Down syndrome Encephalopathy Hypoxic ischemic encephalopathy GDD Birth asphyxia. Lennox-Gastaut syndrome Generalized epileptic discharges Hypoxic ischemic encephalopathy & brain atrophy GDD Idiopathic epilepsy Encephalopathy Normal Normal Down syndrome and generalized epilepsy Slow background Normal GDD Wolf-Hirschhorn syndrome (chromosome 4P deletion), hypotonia, meningitis, myoclonic epilepsy Generalized epileptic discharges Meningitis and agenesis of corpus callosum GDD Birth asphyxia. Lennox-Gastaut syndrome Generalized epileptic discharges Occipital encephalomalacia GDD Brain tumor Focal discharges Brain tumor (Dysembryoplastic neuroepithelial) Normal GDD - Global developmental delay, HSV - herpes simplex virus, GM1 - gangliosidosis 1, NCL - neuronal ceroid lipofuscinosis
Patient/Clinical diagnosis EEG Brain imaging Development Stroke and epilepsy Generalized epileptic discharges infarction, watershed, bilateral parietal occipital GDD Infantile spasms, Down syndrome, congenital heart disease Hypsarrhythmia Normal GDD Dravet syndrome Generalized epileptic discharges Atrophy and encephalomalacia post meningitis GDD Birth asphyxia. Lennox-Gastaut syndrome Generalized epileptic discharges Severe atrophy and hypoxia related changes GDD Birth asphyxia Generalized epileptic discharges Severe atrophy and hypoxia related changes GDD Neurometabolic disease, Dandy–Walker malformation, global developmental delay Generalized epileptic discharges & encephalopathy Dandy–Walker malformation and brain atrophy GDD Focal epilepsy Temporal discharges Normal Normal Propionic acidemia, neurodegenerative brain disorder Encephalopathy Atrophy GDD Neurodegenerative brain disorder Encephalopathy Atrophy, white matter abnormalities GDD Hydrocephalus, Arnold-Chiari malformation, MMC (Myelomeningocele) Encephalopathy Hydrocephalus, Arnold-Chiari malformation GDD Chromosomal 18q- syndrom, multiple congenital anomalies Generalized epileptic discharges & encephalopathy Periventricular white matter volume loss, corpus callosum hypoplasia GDD Infantile spasms, hyperglycinemia Hypsarrhythmia brain atrophy, hypoplastic corpus callosum GDD Dysmorphic features, caudal regression syndrome Generalized epileptic discharges White matter volume loss GDD Neurodegenerative brain disease, progression of milestones, hypopituitarism Focal discharges Hydrocephalus GDD Aicardi syndrome Hypsarrhythmia hypoplastic corpus callosum GDD NCL Generalized epileptic discharges Brain atrophy GDD Down syndrome, birth asphyxia Generalized epileptic discharges & encephalopathy Hypoxia changes GDD Preterm, birth asphyxia Generalized epileptic discharges & encephalopathy Brain atrophy GDD Birth asphyxia Encephalopathy Brain atrophy GDD Neurometabolic disease, glutamine synthase deficiency Encephalopathy Colpocephaly with dilation of lateral ventricles GDD Idiopathic epilepsy Generalized epileptic discharges Normal GDD *GDD - Global developmental delay, *NCL - neuronal ceroid lipofuscinosis, MMC - Myelomeningocele
Patient / ASMs before ASMs after VPA 1 (Levetiracetam) 1 (Valproic acid) 1 (Levetiracetam) 2 (Valproic acid, Levetiracetam) 6 (Topiramate, Carbamazepine, Levetiracetam, Lamotrigine, Prednisolone, IVIG) 2 (Valproic acid, Lacosamide) 5 (Prednisolone, Topiramate, Carbamazepine, Levetiracetam, Lamotrigine) 2 (Valproic acid, Topiramate) 4 (Carbamazepine, Levetiracetam, Lamotrigine, Topiramate) 3 (Carbamazepine, Levetiracetam, Valproic acid) 2 (Vigabatrin, Prednisolone) 2 (Vigabatrin, Valproic acid) 2 (Levetiracetam, Phenytoin) 2 (Levetiracetam, Valproic acid) 2 (Vigabatrin, Prednisolone) 1 (Valproic acid) 3 (Levetiracetam, Vigabatrin, Prednisolone) 2 (Valproic acid, Lamotrigine) 3 (Levetiracetam, Clonazepam, Topiramate) 2 (Valproic acid, Levetiracetam) 3 (Levetiracetam, Carbamazepine, Topiramate) 2 (Valproic acid, Levetiracetam) 1 (Levetiracetam) 1 (Valproic acid)) 5 (Clonazepam, Levetiracetam, Phenobarbital, Carbamazepine Topiramate) 2 (Clonazepam, Valproic acid) 2 (Levetiracetam, Topiramate) 1 (Valproic acid) 1 (Levetiracetam) 1 (Valproic acid) 5 (Phenytoin, Levetiracetam, Phenobarbital, Topiramate, Carbamazepine) 3 (Valproic acid, Levetiracetam, Lamotrigine) 2 (Levetiracetam, Topiramate) 1 (Valproic acid) 3 (Levetiracetam, Phenobarbital, Topiramate) 2 (Levetiracetam, Valproic acid) 3 (Levetiracetam, Phenytoin, Topiramate) 2 (Levetiracetam, Valproic acid) 3 (Topiramate, Levetiracetam, Prednisolone) 3 (Clonazepam, Valproic acid, Lamotrigine) 2 (Levetiracetam, Clonazepam) 2 (Levetiracetam, Valproic acid) 3 (Carbamazepine, Topiramate, Clonazepam) 3 (Topiramate, Levetiracetam, Valproic acid) 1 (Levetiracetam) 1 (Valproic acid) 6 (Prednisolone, Vigabatrin, Levetiracetam, Topiramate, Lamotrigine, Clonazepam) 3 (Levetiracetam, Clonazepam, Topiramate) 3 (Levetiracetam, Phenytoin, Topiramate) 1 (Valproic acid) 1 (Levetiracetam) 1 (Valproic acid) 1 (Phenobarbital) 1 (Valproic acid) 1 (Levetiracetam) 1 (Valproic acid) 2 (Levetiracetam, Carbamazepine) 1 (Valproic acid) 2 (Levetiracetam, Carbamazepine) 3 (Levetiracetam, Lamotrigine, Valproic acid) 3 (Vigabatrin, Topiramate, Levetiracetam, Prednisolone) 2 (Vigabatrin, Valproic acid) 6 (Levetiracetam, Lamotrigine, Topiramate, Prednisolone, Clonazepam, Phenytoin) 3 (Levetiracetam, Lamotrigine, Valproic acid) 3 (Leveritacetam, topiramate, phenobarbital) 2 (Levetiracetam, Valproic acid) 4 (Leveritacetam, Topiramate, Phenobarbital, Prednisolone) 2 (Levetiracetam, valproic acid) 4 (Levetiracetam, Topiramate, Carbamazepine, Pyridoxine) 3 (Levetiracetam, Valproic acid, Topiramate) 2 (Levetiracetam, Topiramate) 1 (Valproic acid) 2 (Levetiracetam, Carbamazepine) 1 (Valproic acid) ASMs - antiseizure medications, VPA - valproic acid, IVIG - intravenous immunoglobulin
Patients ASMs before ASMs after VPA 5 (Levetiracetam, Topiramate, Carbamazepine, Phenobarbital, Vigabatrin) 2 (Topiramate, Valproic acid) 1 (Levetiracetam) 1 (Valproic acid) 4 (Levetiracetam, Phenytoin, Phenobarbital, Topiramate) 3 (Levetiracetam, Valproic acid) 3 (Prednisolone, Vigabatrin, Lamotrigine) 3 (Valproic acid, Levetiracetam, Clonazepam) 2 (Levetiracetam, Carbamazepine) 1 (Valproic acid) 3 (Levetiracetam, Carbamazepine, Topiramate) 2 (Levetiracetam, Valproic acid) 4 (Vigabatrin, Prednisolone, Levetiracetam, Lamotrigine) 3 (Valproic acid, Clonazepam, Topiramate) 3 (Levetiracetam, Carbamazepine, Topiramate) 2 (Valproic acid, Clonazepam) 3 (Levetiracetam, Topiramate, Carbamazepine) 2 (Valproic acid, Prednisolone) 3 (Levetiracetam, Topiramate, Valproic acid) 2 (Valproic acid, Topiramate) 2 (Levetiracetam, Lamotrigine) 1 (Valproic acid) 4 (Phenobarbital, Lamotrigine, Levetiracetam, Topiramate) 2 (Levetiracetam, valproic acid) 1 (Topiramate) 2 (Levetiracetam, Valproic acid) Total ASMs 141 94 Mean 2.8 1.8 Median 3 2 - Table 4
- Complete blood counts before and after VPA (White blood cells (WBCs) and platelets, PLT).
Patient WBCs PLT Before After Before After 15.56 13.91 405 309 12.05 11 418 388 8 7 177 201 13.56 8.15 953 616 18.25 9 444 267 10.5 12 319 314 5.77 9.12 382 645 6.6 11.4 222 418 4.3 12 367 190 6.12 8.18 154 507 8 8 500 350 9 12 167 269 13.90 10 389 336 20 9 412 230 7 9.5 228 394 13 12.5 241 290 8 8 405 430 9.5 11 306 351 12.6 10.2 260 387 11 13 355 329 13 9 319 400 10.6 11.7 360 322 10.6 6.0 400 422 11.7 6.2 310 345 15.8 17 529 400 4 11 335 274 4.3 14 269 256 10 15 269 323 7 7 476 318 10 8 413 460 9 6 449 203 17 15 303 254 15 6 275 475 6 8 324 334 5 8 117 136 7 6 250 270 6 8 177 306 9 9 268 374 8 14 398 450 6 7 460 400 7 7 416 380 7 9 299 424 12 7 455 800 15 7 408 490 8 5 600 560 8 10 425 376 4 3 277 280 9 13 324 600 10 12 387 288 13 11 520 329 Ref range 3-14 109/L 150-450 Mean 9.8142 9.6172 358.32 369.4 Variance 14.9 8.8 18257.9 15521.6 SD 3.86 2.97 135.12 124.59 P(T<=t) 2-tail 0.747031 0.58563866 Liver Function Test (Before VPA doses received) AST ALT GGT ALP Birlli(Total) n (%) Normal 32 (64) 45 (90) 44 (88) 40 (80) 50 (100) Low 0 3 (6) 2 (4) 7 (14) (0) Abnormal (High) 18 (36) 2 (4) 4 (8) 3 (6) (0) M±SD 37.8±18.98 33.28±29.7 36.7±42.6 236.5 ± 76.9 3.12 ± 1.12 Liver Function Test (After VPA doses received) Normal Range 28 (56) 44 (88) 36 (72) 39 (78) 50 (100) Low 2 (4) 4 (8) 5 (10) 9 (18) 0 Abnormal (High) 20 (40) 2 (4) 9 (18) 2 (4) 0 M±SD 38±20.13 26.24±15.9 46.58±67.5 233±86.8 2.62±1.21 P-value Sig. (2-tailed) (comparison between each of subcategory of LFTs) F(1.076)=0.435 F(3.372)=0.002 F(2.897)=0.013 F(9.378)=0.002 F(1.011)=0.423
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