L-CARNITINE SUPPLEMENTATION IN CHILDHOOD EPILEPSY - CURRENT PERSPECTIVES

In November 1996, a panel of pediatric neurologists met to update the consensus statement issued in 1989 by a panel of neurologists and meta bolic experts on L-carnitine supplementation in childhood epilepsy. Th e panelists agreed that intravenous L-carnitine supplementation is cle arly indicated for valproate (VPA)-induced hepatotoxicity, overdose, a nd other acute metabolic crises associated with carnitine deficiency. Oral supplementation is clearly indicated for the primary plasmalemmal carnitine transporter defect. The panelists concurred that oral L-car nitine supplementation is strongly suggested for the following groups as well: patients with certain secondary carnitine-deficiency syndrome s, symptomatic VPA-associated hyperammonemia, multiple risk factors fo r VPA hepatotoxicity, or renal-associated syndromes; infants and young children taking VPA; patients with epilepsy using the ketogenic diet who have hypocarnitinemia; patients receiving dialysis; and premature infants who are receiving total parenteral nutrition. The panel recomm ended an oral L-carnitine dosage of 100 mg/kg/day, up to a maximum of 2 g/day. Intravenous supplementation for medical emergency situations usually exceeds this recommended dosage.