Different sensitivity to sodium valproate in healthy, non-tumoral and tumoral hyperprolactinemic subjects

Effect of Sodium Valproate Treatment on the Cardiac Index in New Cases with Status Epilepticus

Background:

Sodium valproate is an antiepileptic drug primarily used to treat status epilepticus [SE]; however, its effect on cardiac function is unclear. This study aimed to examine the effect of 6 months of sodium valproate treatment on the cardiac index in new cases with status epilepticus.

Methods:

In this cross-sectional study, 30 cases with status epilepticus [18 boys and 12 girls] who were admitted to the Pediatric Intensive Care Unit of Hazrat-e Rasool Hospital were enrolled. Information on basic demographic and clinical data of all children, such as age, weight, gender, blood pressures, and underlying diseases, was recorded. Echocardiography and electrocardiogram [ECG] were performed for all cases before and after the treatment.

Results:

There were no abnormalities in ECG parameters [including PR, QRS, and QT intervals] after 6 months of treatment with sodium valproate. No significant differences were found in echocardiographic parameters, including blood pressure, pulmonary artery pressure [PAP], right ventricular [RV] size, diastolic dysfunction,], Tie index, end-diastolic volume [EDV], ejection fraction [EF], and TAPSE before and after study [p>0.05].

Conclusion:

Administration of sodium valproate over 6 months is not associated with a serious adverse effect on heart function in children with status epilepticus.

The effect of long-term antipsychotic treatment on prolactin

OBJECTIVE

This naturalistic, cross-sectional study was designed to assess the risk of prolactin level elevation and associated side effects in youths taking long-term atypical antipsychotic medication.

METHOD

Subjects were enrolled from outpatient child psychiatric treatment settings in upstate New York who were taking risperidone, olanzapine, or quetiapine for at least 6 months. Demographic data, medication history, and side effects were elicited at the initial interview. Two fasting morning serum prolactin levels were obtained 1 month apart, and the results were averaged.

RESULTS

Fifty outpatient youths, with a median age of 13 years, were enrolled in the study. The median overall duration of use of an atypical antipsychotic was 22.1 months. The median dose of medication for risperidone was 1.5 mg/day, for olanzapine 10 mg/day, and for quetiapine 200 mg/day. The mean prolactin level among all patients on risperidone was significantly greater than controls, as well as for those on quetiapine or olanzapine.

CONCLUSIONS

The risk of hyperprolactinemia with long-term use of risperidone appears to be significantly greater than for olanzapine or quetiapine. Overt side effects were infrequent in the overall sample, but serum prolactin assessment is recommended for youths taking risperidone chronically. Because of variability found in sequential prolactin samples, repeat samples may be warranted.

Effect of risperidone on prolactinoma growth in a psychotic woman

OBJECTIVE

The case of a psychotic woman is described in which risperidone use was found to correspond with an increase in the size of a prolactinoma and prevented the return of serum prolactin level to baseline.

METHODS

Although the patient had been treated with a high dose of bromocriptine, her prolactin level remained elevated, causing persistent galactorrhea. The patient later was treated with olanzapine and carbamazepine successfully.

RESULTS

This case report highlights the role of risperidone on prolactin and discusses alternative methods of treating psychosis when the etiology is unclear, especially in younger patients.

CONCLUSIONS

The authors recommend that additional studies regarding the relationship between the growth of prolactinoma and atypical antipsychotics would be worthwhile.