Binek J, Hany A, Egloff B, Heer M
Medizinische Klinik, Kantonsspital Winterthur.
Schweiz Med Wochenschr. 1991 Feb 16;121(7):228-33.
Fatal hepatic failure associated with valproic acid therapy is a rare side effect occurring in 1:5000-10,000 of the patients exposed to this antiepileptic drug. Its relevance arises from its fatal outcome and the high number of patients who are treated with this drug (one million worldwide in 1988). 112 cases were published up to 1988. Most of the affected patients were young (less than 10 years old), male, and mentally retarded. Many were under antiepileptic polytherapy. The children of this age group constituted only 23% of the patients treated with valproic acid but 73% of all fatalities. 90% of the patients developed hepatic failure in the first 5 months of therapy. Low doses or therapeutic serum levels of valproic acid do not prevent this dramatic event. Specific therapy is not known. In addition to the case report we review the literature and make recommendations for monitoring therapy with valproic acid.
丙戊酸治疗相关的致命性肝衰竭是一种罕见的副作用，在使用这种抗癫痫药物的患者中发生率为1:5000至10000。其相关性源于其致命后果以及使用该药物治疗的患者数量众多（1988年全球有100万）。截至1988年共发表了112例病例。大多数受影响的患者为儿童（小于10岁）、男性且智力发育迟缓。许多患者接受多种抗癫痫药物联合治疗。这个年龄组的儿童仅占接受丙戊酸治疗患者的23%，但却占所有死亡病例的73%。90%的患者在治疗的前5个月内发生肝衰竭。低剂量或治疗性血清水平的丙戊酸并不能预防这一严重事件。目前尚无特效治疗方法。除了病例报告外，我们还回顾了文献并对丙戊酸治疗的监测提出建议。
