背景：Valproic acid及carbamazepine是兩種最常用於治療癲癇孩童之抗癲癇藥物。以成年癲癇病患為研究對象指出，施以單一藥物valproic acid治療之成人，其罹患非酒精性脂肪肝的機會，遠高於以carbamazepine治療之癲癇患者。但是在癲癇孩童方面，卻少有研究著墨。另有學者指出，非酒精性脂肪肝在組織發生學上，孩童迥異於成人。所以我們假設對於癲癇孩童，valproic acid易造成非酒精性脂肪肝的罹患率，並嘗試分析其所潛藏之危險因子。

實驗方法：107位接受valproic acid及carbamazepine單一藥物治療之癲癇孩童，紀錄其人口統計學之特徵，並取得藥物治療前、後之血液生化數值做分析，並以肝臟超音波探究非酒精性脂肪肝之情況。

結果：以valproic acid治療，相較於以carbamazepine治療之癲癇孩童，有較高的比例罹患非酒精性脂肪肝(32% 及 12.3%, p<0.01)。兩者治療前後之身體質量指數(body mass index)及肝酵素指數(ALT)並無明顯別；同樣情形亦見於投與藥物後之總膽固醇(total cholesterol)、三酸甘油脂(triglyceride)及空腹血糖(fasting glucose)等生化數值。我們也發現，在valproic acid治療族群中，罹患非酒精性脂肪肝的孩童年紀大多超過六歲以上，且這些孩童相較於未罹患酒精性脂肪肝之病童，治療前有較高之肝酵素指數(ALT)。

結論：根據我們的研究，接受valproic acid單一藥物治療之癲癇孩童，較易罹患非酒精性脂肪肝。所以我們建議這些孩童應定期做肝臟超音波的檢查，尤其是年齡大於六歲及接受藥物治療前之肝酵素指數(ALT)較高者。

Background: Valproic acid and carbamazepine are two of most commonly used antiepileptic drugs in the treatment of epileptic children. Previous issue suggests that after more than ten years of antiepileptic drugs treatment, nonalcoholic fatty liver disease (NAFLD) were found more in valproic acid-treated adult patients than receiving carbamazepine. However, few data is available about NAFLD and valproic acid-treated epileptic children. We hypothesize that valproic acid does induce nonalcoholic fatty liver disease in treating epileptic children, and try to find out the potential risk factors.

Methods: 107 epileptic children who received monotherapy of valproic acid and carbamazepine were enrolled. Biochemical data before and after treatment, and demographic characteristics were collected. Liver ultrasonography was performed for determining NAFLD condition.

Results: Our study demonstrated that the valproic acid-treated epileptic children had a higher percentage of NAFLD than carbamazepine group did (32% vs. 12.3%, p<0.01). Both groups did not differ in the body mass index and alanine aminotransferase (ALT) levels before and after antiepileptic drugs treatment, neither did total cholesterol, triglyceride and fasting glucose levels after treatment. Valproic acid-induced NAFLD tended to occur in patients older than six years old. Higher ALT level was also found before valproic acid treatment with NAFLD than patients without NAFLD.

Conclusion: Epileptic children who receive valproic acid monotherapy are susceptible to NAFLD. Therefore, abdominal ultrasound screen is suggested in children older than 6 years old, and those patients who show elevated normal ALT level before treatment.

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