Prevalencia de obesidad y síndrome metabólico en pacientes pediátricos con epilepsia tratados en monoterapia con ácido valproico / The prevalence of obesity and metabolic syndrome in paediatric patients with epilepsy treated in monotherapy with valproic acid

RESUMEN

Introducción. El ácido valproico (VPA) es un antiepiléptico útil para controlar diferentes tipos de epilepsia. Tiene efectos colaterales y se asocia a incremento del peso corporal y a alteraciones metabólicas y endocrinas, entre ellas síndrome metabólico. Objetivo. Conocer la prevalencia de la obesidad y el síndrome metabólico en pacientes pediátricos con epilepsia tratados en monoterapia con VPA. Pacientes y métodos. Estudio transversal, observacional, analítico. Se estudiaron pacientes tratados con VPA entre 2010- 2014, y se midió el índice de masa corporal (IMC), el perímetro abdominal, la presión arterial, la glucosa, los triglicéridos y las lipoproteínas de alta densidad (HDL), en búsqueda de obesidad y síndrome metabólico. La obesidad se definió con un IMC mayor del percentil 95; el síndrome metabólico, con al menos tres de los siguientes criterios perímetro abdominal mayor del percentil 90, presión arterial sistémica mayor del percentil 90, triglicéridos mayores de 110 mg/dL y HDL menor de 40 mg/dL. Resultados. Se estudiaron 47 pacientes con una edad media de 10,1 ± 4 años; el 51,06% eran varones. Ocho (17%) desarrollaron obesidad y, de ellos, dos (25%), síndrome metabólico. Tres pacientes desarrollaron sobrepeso (6%). Observamos diferencias estadísticamente significativas de media de edad comparados con los grupos de IMC, donde los pacientes obesos eran adolescentes (ANOVA; p = 0,0001), y aquellos que tomaban más VPA al día eran los obesos (ANOVA; p = 0,024). Conclusiones. Los pacientes tratados con VPA que se convierten en obesos pueden desarrollar síndrome metabólico. Requieren una monitorización cuidadosa y, ante la presencia de ganancia de peso, se deberá valorar la retirada del fármaco (AU)

ABSTRACT

Introduction. Valproic acid (VPA) is a useful antiepileptic drug for controlling different types of epilepsy. It has several side effects and is associated to increased body weight, as well as metabolic and endocrine disorders, including metabolic syndrome. Aim. To determine the prevalence of obesity and metabolic syndrome among paediatric patients with epilepsy treated in monotherapy with VPA. Patients and methods. The study was cross-sectional, observational and analytical. A sample of patients treated with VPA between 2010-2014 were studied and the body mass index (BMI), abdominal perimeter, arterial blood pressure, glucose, triglycerides and high density lipoproteins (HDL) were studied in search of obesity and metabolic syndrome. Obesity was defined as a BMI above the 95th percentile, and metabolic syndrome was considered if at least three of the following criteria were fulfilled abdominal perimeter above the 90th percentile, systolic arterial pressure above the 90th percentile, triglycerides above 110 mg/dL and HDL below 40 mg/dL. Results. A total of 47 patients with a mean age of 10.1 ± 4 years were studied; 51.06% were males. Eight (17%) of them developed obesity and, of those, two (25%) had metabolic syndrome. Three patients went on to become overweight (6%). Statistically significant differences were observed in the mean age in comparison to the BMI groups, where the obese patients were adolescents (ANOVA, p = 0.0001) and those who took more VPA per day were the obese (ANOVA, p = 0.024). Conclusions. Patients treated with VPA who become obese may go on to develop metabolic syndrome. They require careful monitoring and, if they are seen to put on weight, withdrawal of the drug should be considered (AU)