Magazine article The Exceptional Parent


Magazine article The Exceptional Parent


Article excerpt

Controversy persists about the role of carnitine in epilepsy. Research reports started coming out in 1982 and have accelerated ever since. A review of these research reports, such as that by Dr. David Coulter in the Journal of Child Neurology, would benefit both physicians and parents. Both clinicians and parents still need answers to questions of when to measure carnitine levels and when to provide treatment with carnitine. The purpose of that review was to summarize the available data in order to help physicians answer those questions. In particular, it sought to identify risk factors that might help anticipate carnitine deficiency and to predict the response to treatment.

This article adapts the findings from Dr. Coulter's lengthy examination, translating them from the language of scientists to that of parents and other caregivers. Please note, EXCEPTIONAL PARENT does not usually refer to children as "patients." However, because the research reviewed here was the result of clinical trials, we have kept that designation.

Two results are immediately available:

* carnitine deficiency is not uncommon in patients with epilepsy;

* some patients appear to benefit from carnitine treatment.

Please also note that treatment with carnitine refers to the use of prescription medication available under the brand name Carnitor as tablets, oral solution, and intravenous injection. While non-prescription carnitine products are also available as dietary supplements from health food stores, they are marketed for athletic rather than therapeutic use and are not subject to the same regulatory requirements for quality control as prescription products.

-- J.C.S.

Identifying risk

Faced with a particular type of disorder--in this case, epilepsy--physicians need to know whether carnitine deficiency is present and whether that person's disorder is likely to benefit from carnitine treatment. The data reviewed suggested that it may be possible to identify risk factors for carnitine deficiency in people with epilepsy.

The data from these studies identified 10 risk factors for carnitine deficiency. They are:

* a young age (less than 10 years old);

* inability to move about on one's own;

* being underweight;

* multiple neurological disabilities, including mental retardation, cerebral palsy, and blindness;

* therapy with multiple anticonvulsant drugs, including valproate;

* hyperammonemia (an excess of ammonia in the blood);

* hypoglycemia (deficiency of blood sugar);

* metabolic acidosis (excessive amount of acid in blood due to metabolic problems);

* intravenous tube feeding;

* a diet low in meat and dairy products.

When these risk factors are absent, carnitine deficiency appears to be unlikely and measurement of carnitine levels is generally unnecessary. Thus, measurements of carnitine levels are not necessary in all patients. When several of these risk factors are present, however, the likelihood of carnitine deficiency is increased and measurement of carnitine levels is worth considering.

Measuring carnitine

Measurements are taken from blood and tissue tests. The choice of which test to use can be important. Mildly reduced carnitine levels that are still within the normal range may be of no clinical significance, but careful attention is warranted when carnitine deficiency shows up in blood tests. Carnitine deficiency in tests of muscle tissues may exist even when blood carnitine levels are normal, but muscle biopsy as a measurement of carnitine levels is ordinarily not routine in patients with epilepsy.

Generally, researchers found that when using blood tests, carnitine levels dropped lower in patients taking valproate than in those who were in control groups. However, this was not true in all studies. In some, these differences were not significant. …

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