Affiliations: Department of Pediatrics, Faculty of Medicine, Ain
Shams University, Cairo, Egypt | Department of Clinical Pathology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
Abstract: Acute pancreatitis associated with valproic acid (VPA) treatment is
reported in literature. Amylases however are not specifically originated in the
pancreas. Other organs, such as salivary glands, may be involved in causing
higher serum activity. Thus, we aimed to investigate whether serum total
amylase and particularly its pancreatic isoenzyme and lipase levels are altered
in the course of treatment with VPA in children with epilepsy. The study was
conducted on 45 children with epilepsy on VPA monotherapy. Trough serum VPA,
serum total amylase, lipase, and pancreatic amylase levels were evaluated in
the patients and results were compared to a matched control group. Though all
patients were asymptomatic for acute pancreatitis, serum total amylase levels
were elevated in 40%. Patients with increased levels of total amylase did
not differ from the rest of patients regarding the characteristics of epilepsy
syndrome or the degree of seizure control. Nevertheless, there was significant
positive correlation between total amylase and VPA trough serum levels. Five
patients had simultaneous elevation of total amylase, pancreatic isoenzyme and
lipase levels, though in none of them reaching three folds the upper limit.
They had no symptoms suggestive of acute or intermittent pancreatitis and their
ultrasonic examination was normal. Follow up showed normalization of their
serum levels. In conclusion, our results demonstrate the limited specificity of
total amylase level as a marker for pancreatic injury. Whenever there is
suspicion, a workup including pancreatic isoenzymes is advisable. The
implication of asymptomatic elevation of pancreatic isoenzymes needs to be
further investigated.
