The Efficacy of Routine Liver Function Test Follow Up in Epileptic Children

Pee, Dae Hun; Sohn, Hyung Joo; Shin, Young Kyoo; Eun, Baik Lin; Park, Sang Hee; Kim, Soon Kyum

Abstract

PURPOSE: Routine liver function test follow up is done in epileptic children receiving antiepileptic drugs to prevent hepatotoxicity induced by these drugs. But rarely seen are the abnormalities of liver function test, and seldomly are these abnormalities accompanied by the clinical manifestation. This study is carried out to assess the efficacy of routine liver function test follow up in epileptic children.
METHODS
We determined the changes of the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, direct bilirubin, total protein, albumin, gamma-glutamyltransferase (gamma-GT) and alkaline phosphatase before and 3, 6, 12 months and 2 years after antiepileptic drug medication in 59 epileptic children who had been receiving carbamazepine (n=16), phenobarbital (n=14), valproic acid (n=10) and combination of these (n=19) for 2 to 5 years.
RESULTS
1) The difference in liver function test follow up according to the age and sex was not found and there was no statistical correlationship between drug medication time and the serum drug level. 2) AST and ALT had been within normal range for all the study period in any group. 3) Total bilirubin had been within normal range for all the study period in any group. Direct bilirubin had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 4) Total protein and albumin had been within normal range for all the study period in any group. 5) gamma-GT had the increasing tendency for all the study period in valproic acid group, but the values had been within normal range for all the study period. 6) Alkaline phosphatase had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 7) No clinically significant hepatic manifestation had developed during study period in any group.
CONCLUSIONS
Our data suggest that routine liver function test follow up itself can not be the indicator of hepatotoxicity and that liver function test in need when accompanied by the development of clinical hepatic manifestation is more efficacious than routine liver function test follow up.