Fatal hepatic necrosis associated with multiple anticonvulsant therapy.

We report six fatal cases of hepatic necrosis in children associated with multiple anticonvulsant therapy. There was insufficient evidence to incriminate any single drug or combination of drugs, but it is noteworthy that sodium valproate was involved in only one case. We consider that an idiosyncratic metabolic reaction to the anticonvulsants was most likely. In five of the six cases hepatic failure was immediately preceded by a prolonged fit and we speculate that metabolic change from excessive neuronal activity may unmask the hepatotoxicity of anticonvulsants.