Weight gain associated with valproate in childhood

Weight gain is a common side effect of valproate treatment. Several mechani sms have been suggested for its pathophysiology; of these, impairment of be ta-oxidation of fatty acids and increased insulin secretion have been suppo rted by clinical studies, To investigate whether changes in carnitine and i nsulin levels had a role in the weight gain occurring with valproate treatm ent in children, 20 patients with epilepsy were randomly assigned to receiv e either carnitine or placebo supplementation in addition to valproate. Aft er a follow-up period of 3 months, weight gain was observed in both groups. The mean insulin concentration and insulin/glucose ratios increased. Weigh t gain did not correlate with carnitine levels. These results suggest that weight gain during valproate treatment is not related to a decrease in carn itine levels. However, an increase in insulin levels together with a decrea se in glucose levels may cause weight gain, possibly by stimulating appetit e. (C) 2000 by Elsevier Science Inc. All rights reserved.