الفهرس 
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Abstract
Although there weren’t much data about the occurrence of protein aversion in patients on valproate therapy, yet, observing many patients on valproate whose parents complaining of protein aversion provoked us to conduct this study.
The Aim of this work was to study the relationship between protein aversion and valproate therapy in epileptic children and whether it is related to ammonia level or not.
Our cross sectional study was conducted on two groups (patient group and control group). Each group included 45 children from 2 to 16 years old fulfilling the inclusion citeria. They were recruited during the period of September 2016 to December 2017.
The patient group included 23 males and 22 females recruited from Pediatric Neurology Clinic, Children’s Hospital, Faculty of Medicine, Ain Shams University. They were further subdivided into two subgroups A & B (subgroup A included patients with protein aversion, subgroup B included patients without protein aversion).
The control group included 17 males and 28 females. They were apparently normal children recruited from the siblings of the children attending the Outpatients’ clinic, Children’s Hospital, Faculty of Medicine, Ain Shams University.
All children were subjected to full history taking with special emphasis on age, gender, history of consanguinity, perinatal history, developmental history, dietary history. Also a full clinical examination was done with special emphasis on signs of nutritional defect or vitamin deficiency. A questionnaire was conducted for inquiring about presence of protein aversion and food frequency consumption. Ammonia level assessment was conducted in all children.
Besides, patient group only were subjected to history of epilepsy, history of seizures, history of valproate therapy (dose, duration and its relation to protein aversion) and laboratory studies of CBC and liver functions.
In The current study there was no statistically significant difference between the epileptic patients and control group regarding age or sex. However, there was significantly higher family history of epilepsy in the patient group compared to the control group.
A highly significant difference in protein aversion especially for meat between the two study groups was reported being significantly higher in patient group on valproate therapy.
The majority of patients with protein aversion developed aversion after starting valproate therapy (84%) by 7.84 ± 3.28 months.
Ammonia level was significantly higher in the patient group on valproate therapy compared to control group. Yet, there was no significant statistical relationship between ammonia level and valproate therapy regarding dose and duration of therapy.
Also, there was no significant relation between ammonia level and protein aversion in epileptic children on valproate therapy.
L-carnitine intake wasn’t related to presence of protein aversion. Also, the study revealed no statistical significant relation between ammonia level and l-carnitine therapy.