Some antiepileptic drugs (AEDs) may alter trace element metabolism and free radical scavenging enzyme activities in humans and experimental animals. We investigated the effect of long-term AED therapy on copper (Cu), zinc (Zn), manganese (Mn), selenium (Se), magnesium (Mg), glutathione peroxidase (GSH-PX), and superoxide dismutase (SOD) in the plasma in children with epilepsy. During treatment with valproate (VPA) or carbamazepine (CBZ) monotherapy plasma Cu, Zn, Mn, Se, and Mg concentrations of patients were not statistically different from those of control subjects. The level of serum VPA weakly correlated with the increase in plasma Zn level. Recent studies suggest that membrane lipid peroxidation may be causally involved in some forms of epilepsies, and the decreased free radical scavenging enzyme activity is believed to cause the increased risk of an idiosyncratic drug reaction encountered in the management of epilepsy. Because GSH-PX and SOD are the most important members of antioxidant defense mechanisms, we quantitated the activities of these enzymes in plasma of children with epilepsy receiving VPA or CBZ. Only plasma GSH-PX activities in VPA group were higher than those of the control group, and the difference was statistically significant.

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Measurement of vanillylmandelic acid (4-hydroxy-3 methoxy-mandelic acid or VMA) in the urine of patients with neuroblastoma has become part of the routine work up, since its presence was described by Voorhess and Gardner in 1960.1 When quantitative measurements of this catecholamine metabolite are performed, the patient must be placed on a strict diet for 2 to 3 days to eliminate substances whose breakdown products appear in the urine and give false positive results. The numerous items which must be excluded are beverages such as tea, colas, and Kcol-Aid, desserts and pastries flavored with chocolate and vanilla, and a variety of fruits including oranges, bananas, grapes, and tomatoes.

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