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All Journal Medicina E-Jurnal Medika Udayana Media Penelitian dan Pengembangan Kesehatan BULETIN PENELITIAN SISTEM KESEHATAN Medical Journal of Indonesia Sari Pediatri Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) ISM (Intisari Sains Medis) : Jurnal Kedokteran

I Gusti Ngurah Made Suwarba

Bagian/SMF Ilmu Kesehatan Anak RSUP Sanglah, Fakultas Kedokteran Universitas Udayana

Author-ID : 397687

Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Environmental Science Health Professions Immunology & microbiology Mechanical Engineering Medicine & Pharmacology Neuroscience Public Health

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The Effect of Carnitine Supplementation on Blood Ammonia Level in Epilepsy Children Treated with Valproic Acid: A Randomized Controlled Trial I Gusti Lanang Sidiartha; I Gusti Ngurah Made Suwarba; Dyah Kanya Wati; Ida Bagus Subanada
Molecular and Cellular Biomedical Sciences Vol 5, No 1 (2021)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v5i1.177

Background: Long-term use of valproic acid is associated with a high level of blood ammonia related to carnitine deficiency. This study investigates the effect of carnitine supplementation on blood ammonia levels in children with epilepsy who have been treated with valproic acid for more than six months.Materials and Methods: This was a randomized, double-blind, placebo-controlled trial study where children with epilepsy who were treated with valproic acid were randomly allocated to the carnitine supplementation and control group. All children were followed for month, and then measured for blood ammonia level. Blood ammonia levels of both groups were compared using an Independent t-test with a significant of p<0.05.Results: Total of 32 children with epilepsy were enrolled as subjects in this study, with 16 children in carnitine group, and 16 children in control group. Among the subjects, 50% were male and 50% were female, with a mean age of 6.5 years old. The average duration of epilepsy in the carnitine and control group were 41.7 months and 36.9 months, respectively (p=0.419). The duration of valproic acid therapy in the carnitine and control group were 33.1 months and 27.6 months, respectively (p=0.483). The level of blood ammonia in carnitine and control group were 44.6 mg/dL and 81.4 mg/dL, respectively (p=0.007).Conclusion: The level of blood ammonia in a carnitine group was significantly lower than in a control group. It is recommended to give carnitine supplementation in epileptic children treating with long-term valproic acid.Keywords: ammonia, carnitine, epilepsy, seizure, valproic acid

Correlation Between Pyridoxal 5’-Phospate Level And Valproic Acid In Epilepsy Children I Gusti Ngurah Made Suwarba; Ni Putu Yunik Novayanti; I Gusti Lanang Sidiartha; Dewi Sutriani Mahalini
Molecular and Cellular Biomedical Sciences Vol 3, No 1 (2019)
Publisher : Cell and BioPharmaceutical Institute

Background: It is important to maintain the adequate level of vitamin B6 to ensure stable metabolism. Vitamin B6 serum level might decreased by absorption disturbance or increasing demand. Valproic acid increase the synthesis of serum GABAergic in the other hand vitamin B6 is required as cofactor for gamma-amino butyric acid (GABA) formation. The dosage and duration of valproic acid therapy might be correlated with vitamin B6 serum level. The aim of this study is to know the correlation between vitamin B6 serum level against dosage and duration of valproic acid therapy in children with epilepsy.Materials and Methods: This is a cross sectional study to investigate the correlation between vitamin B6 serum level against dosage and duration of valproic acid therapy. The level of vitamin B6 serum was determined by checking vitamin B6 active form in serum, pyridoxal 5’-phospate (PLP).Results: In this study, 37 epilepsy children with valproic acid duration therapy more than 3 months was enrolled. Fifty six percent epilepsy children were male, commonly on children age 1-5 years old. Spearman correlation coefficient test showed a significant weak negative correlation between vitamin B6 serum level and dosage of valproic acid (r=–0.35; p=0.03), and very weak negative correlation with valproic acid duration therapy (r=-0.08; p=0.59), however it was not significant. Conclusion: There was a significant weak negative correlation between vitamin B6 serum level and very weak negative correlation with valproic acid duration therapy, but not significant in children with epilepsy.Keywords: correlation, valproic acid, vitamin B6

High Blood Ammonia Levels Associated with Long-term Valproic Acids Therapy in Epileptic Children I Gusti Lanang Sidiartha; I Gusti Ngurah Made Suwarba; Dyah Kanya Wati; Ida Bagus Subanada
Molecular and Cellular Biomedical Sciences Vol 4, No 2 (2020)
Publisher : Cell and BioPharmaceutical Institute

Background: Valproic acid is an effective drug for controlling seizure in children with epilepsy and it is usually used for treatment as long as two years or more. Blood ammonia level often increased in epileptic children who were treated with long-term valproic acid. The study was conducted to determine the relationship between blood ammonia level with valproic acid therapy in epileptic children.Materials and Methods: This is an observational study with cross-sectional approach. The subjects were 64 children with epilepsy, average age of 6.2 years old. Subjects were 33 boys and 31 girls. Blood ammonia level was examined using enzymatic glutamate dehydrogenase. Subjects were divided into 2 therapeutic groups based on the duration, doses and combination therapy of valproic acid. Subjects were recruited from Pediatric Neurology Clinic, Sanglah General Hospital, Bali, Indonesia, from May to December 2017. Comparison of blood ammonia level between groups were analyzed using an Independent t-test with significances if the p<0.05.Results: A significant difference of blood ammonia level was found between subjects who were treated with valproic acid less than 2 years and more than 2 years (45.7±16.4 mmol/L vs. 70.9±43.6 mmol/L; p=0.032). However, significant difference was not found between the groups according to the doses and combination therapy (p=0.450 and p=0.647, respectively).Conclusion: Blood ammonia level was significantly higher in epileptic children who used long-term valproic acid, hence it was recommended to check the blood ammonia level routinely.Keywords: ammonia, epilepsy, valproic, children

Co-Authors Anita Purnamayanti Bagus Ngurah Putu Arhana Deborah Melati, Deborah Dewi Sutriani Mahalini Dwi Putro Widodo Dyah Kanya Wati Dyah Kanya Wati Hendra S I Gde Raka Widiana I Gusti Lanang Sidiartha I Gusti Ngurah Agung Jayadhi Widyakusuma I Gusti Ngurah Sanjaya Putra I Made Darma Yuda I Made Kardana I Nyoman Budi Hartawan I Putu Hendri Aryadi Ida Bagus Gede Suparyatha Ida Bagus Subanada Ida Bagus Subanada IKG Suandi Ketut Ariawati Komang Kari Made Gede Dwi Lingga Utama Made Suadnyani Pasek Ni Made Dani Febriansiswanti Ni Nyoman Ayu Semanggiasih Ni Putu Yunik Novayanti Ni Putu Yunik Novayanti Ni Wayan Kurnia Wati Novayanti, Ni Putu Yunik RA Setyo Handryastuti Sekarningrum, Putu A. Sudaryat S Susanti Halim Tri Yuliantini Wati, Dyah K. Wayan Sulaksmana Sandhi Parwata

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