Association Between Duration of Valproic Acid Therapy, Serum calcium Levels, and Nutritional Status in Children with Epilepsy

Abstract

Background: Valproic acid, a common antiseizure medication for pediatric epilepsy, is linked to metabolic disturbances including calcium metabolism changes and weight gain. Limited evidence exists on the relationship between therapy duration, serum calcium levels, and children's nutritional status in Indonesia. This study evaluated this association in pediatric epilepsy patients.

Methods: A cross-sectional study was conducted from November 2025 to January 2026 at Dr. Wahidin Sudirohusodo Hospital, Makassar. Pediatric patients aged 6 months–18 years with epilepsy receiving valproic acid monotherapy for ≥3 months were included. Participants were categorized according to therapy duration into ≤6 months and >6 months groups. Demographic data, anthropometric measurements, nutritional status, and serum calcium levels were obtained from medical records.

Results: A total of 48 children were included. The proportion of hypocalcemia was higher in the >6 months therapy group (70.8%) compared with the ≤6 months group (58.3%) (p=0.365). The mean serum calcium level was lower in the >6 months group (7.3 ± 2.8 mg/dL) than in the ≤6 months group (8.0 ± 2.3 mg/dL) (p=0.523). Most participants in both groups had normal nutritional status, with no significant difference between groups (p = 0.505), though obesity was observed only in children receiving valproic acid therapy for >6 months.

Conclusion: Longer valproic acid therapy showed a tendency toward lower serum calciumlevels and a higher proportion of obesity among children with epilepsy, although no significant association with hypocalcemia was observed. Regular monitoring of metabolic and nutritional status is recommended in pediatric patients receiving prolonged valproic acid therapy.