The Weschler Intelligence Scales for Children was applied to 64 epileptic children and 60 healthy subjects; patients followed chronic treatment with valproic acid (n = 32) or phenobarbital (n = 32). None of the children suffered mental retardation or neurological abnormalities. The test was repeated after a 9–12 month interval: 26 of the valproatetreated children and 23 of the phenobarbital‐treated children performed the second evaluation. At baseline, total, verbal and performance IQ scores of children receiving phenobarbital were lower than those of controls. When the results of the first and the second tests were compared, a significant increase in IQ scores was detected among controls and patients treated with valproic acid, but not among phenobarbital‐treated patients. It is concluded that long‐term phenobarbital therapy induces a significant impairment in learning ability whereas long‐term vaiproate therapy does not exert a noticeable noxious effect at this respect.

This open-label, randomized study compared the efficacy of a regimen of corticosteroids and tacrolimus (standard therapy group, n ϭ 79) with a regimen of daclizumab induction therapy in combination with mycophenolate mofetil and tacrolimus (modified therapy group, n ϭ 78) in primary liver transplant recipients. The primary endpoint was biopsy-proven acute rejection (BPAR) at 24 weeks. Secondary endpoints included time to rejection and patient and graft survival. The incidence of BPAR was significantly reduced in the modified therapy group compared to the standard therapy group (11.5% versus 26.6%, respectively, P ϭ 0.017). The time to rejection was significantly shorter in the standard therapy group compared with the modified therapy group (P ϭ 0.044). There was no significant difference between groups in patient or graft survival. Hepatitis C virus-positive patients exhibited no differences from hepatitis C virus-negative patients with respect to the incidence of BPAR. A steroid-sparing regimen of daclizumab, mycophenolate mofetil, and tacrolimus was effective and well tolerated in the prevention of BPAR in adult liver transplant recipients in comparison with a standard regimen of tacrolimus and steroids. Liver Transpl 15:1542-1552, 2009. © 2009 AASLD. Received February 5, 2009 accepted May 26, 2009. Standard immunosuppressive therapy after liver transplantation is based on calcineurin inhibitors (CNIs) and corticosteroids.1 Although corticosteroids are still widely used as maintenance immunosuppression for most liver transplant recipients, tacrolimus has supplanted cyclosporine as the CNI of choice.1,2 In the United States alone, 89% of liver transplant recipients currently receive tacrolimus, whereas less than 10% receive cyclosporine. 1 However, both tacrolimus and corticosteroids are associated with serious side effects, including nephrotoxicity (tacrolimus) and hypertension and metabolic effects (corticosteroids).2 Thus, alternative immunosuppressive regimens that minimize the use of tacrolimus or corticosteroids have been sought. [3][4][5]

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