Effects of l-carnitine supplementation in patients with childhood-onset epilepsy prescribed valproate

• Published in: Epilepsy & behavior 2021-09, Vol.122, p.108220-108220, Article 108220
• Main Authors: Okumura, Akihisa, Takagi, Mizuki, Numoto, Shingo, Iwayama, Hideyuki, Azuma, Yoshiteru, Kurahashi, Hirokazu
• Format: Article
• Language: English
• Subjects: Ammonia; Amylase; Carnitine; Valproate
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2021.108220

•Serum-free carnitine levels were maintained within the normal range by carnitine supplementation.•Serum-free carnitine levels were low in a half of patients taking VPA without carnitine supplementation.•Serum amylase levels were lower in patients taking VPA with carnitine supplementation. The benefits of carnitine supplementation in patients treated with valproate (VPA) are not clear. Therefore, we retrospectively explored the benefits of carnitine supplementation by analyzing laboratory data. We measured the serum-free carnitine (FC), VPA, aspartate aminotransferase, alanine aminotransferase, amylase, and ammonia levels, and the platelet count, in 69 patients with childhood-onset epilepsy treated with VPA. Eight patients had received carnitine supplementation. The serum FC and acylcarnitine levels were measured using an enzyme cycling method. We compared laboratory values between patients with and without carnitine supplementation and analyzed the correlations between serum FC levels and laboratory values. The serum FC levels were normal (median, 48.8 μmol/L; range: 41.9–68.3 μmol/L) in all eight patients with carnitine supplementation, but below normal in 32 of 61 patients without supplementation. The median serum amylase levels were lower in the patients with carnitine supplementation (median, 48 U/L; range: 27–149 U/L) than in those without (median, 7 U/L; range: 14–234 U/L). The platelet count and serum ammonia levels did not differ significantly between patients with and without supplementation. There was no significant correlation between the serum FC level and the platelet count, serum amylase level, or ammonia level. Carnitine supplementation helps maintain serum FC levels in patients treated with VPA. The lower serum amylase levels in patients with carnitine supplementation may reflect protective effects of carnitine against latent pancreatic injury.