Published online March 10, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e920-e926 (doi:10.1542/peds.2007-1631)

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ARTICLE

Amino Acid Cerebrospinal Fluid/Plasma Ratios in Children: Influence of Age, Gender, and Antiepileptic Medication

Sabine Scholl-Bürgi, MD^a, Edda Haberlandt, MD^a, Peter Heinz-Erian, MD^b, Florian Deisenhammer, MD, MSc^c, Ursula Albrecht, MD^a, Sara Baumgartner Sigl, MD^a, Markus Rauchenzauner, MD^a, Hanno Ulmer, PhD^d, Daniela Karall, MD^a

Divisions of ^a Neonatology, Neuropediatrics, and Inborn Errors of Metabolism
^b Gastroenterology, Hepatology, and Oncology, Department of Pediatrics
^c Clinical Department of Neurology
^d Department of Medical Statistics, Informatics, and Health Economics, Innsbruck Medical University, Innsbruck, Austria

OBJECTIVE. The purpose of this work was to investigate the influence of age, gender, and antiepileptic therapy on amino acid cerebrospinal fluid/plasma ratios in children.

PATIENTS AND METHODS. Concentrations of 17 amino acids measured by ion-exchange chromatography with ninhydrin detection in plasma and cerebrospinal fluid from 68 patients with neurologic diseases were used to calculate their cerebrospinal fluid/plasma ratios (70 measurements; 28 female patients [29 punctures] and 40 male patients [41 punctures]). Age dependence and the effects of gender and antiepileptic medication on amino acid cerebrospinal fluid/plasma ratios were investigated by linear multiple regression analysis, and nonstandardized predicted mean values for 2 age groups were calculated (cutoff: 3 years old).

RESULTS. The cerebrospinal fluid/plasma ratios ranged between 0.02 for glycine and 0.93 for glutamine. Age had a significant influence on cerebrospinal fluid/plasma ratios for valine, isoleucine, leucine, and tyrosine, with higher ratios in younger children. Gender had a significant influence only on the glutamine cerebrospinal fluid/plasma ratio (female patients had lower ratios). Cerebrospinal fluid/plasma ratios of glutamine and tyrosine were significantly elevated by valproate therapy and those of serine, asparagine, glutamine, valine, methionine, and phenylalanine by phenobarbital therapy. No significant influence of age, gender, and antiepileptic drugs was detectable on cerebrospinal fluid/plasma ratios of threonine, proline, glycine, alanine, histidine, ornithine, lysine, and arginine.

CONCLUSIONS. Cerebrospinal fluid/plasma ratios, especially for essential neutral amino acids and for serine, asparagine, and glutamine were influenced to different degrees by age, gender, and antiepileptic therapy.

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Key Words: amino acids • blood-brain barrier • CSF/plasma ratios • child

Abbreviations: BBB—blood-brain barrier • CSF—cerebrospinal fluid

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Accepted Sep 6, 2007.

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