Depakote ER can be effective against many types of seizures common in children:

• absence seizures (this is one of the most effective medicines for these brief staring spells)
• myoclonic seizures
• tonic-clonic seizures, such as those in Lennox-Gastaut syndrome.
• seizures triggered by flashing lights

Valproate medicines are also effective for infantile spasms (West syndrome), but the tablet form of Depakote ER makes it unsuitable for that purpose.

Children under 2 or 3 years of age who take valproate in any form have a much higher risk of liver failure than adults or older children. (The risk of liver failure is very low for children over 10, perhaps 1 in 50,000.) The tablet form of Depakote ER means that it's unlikely to be prescribed for very young children anyway, so this is seldom a concern. Liver damage usually occurs within the first 6 months of treatment. The first signs of it are vomiting, loss of appetite, sluggishness, and perhaps loss of seizure control, yellow skin and eyes, or swelling.

Higher-than-usual levels of the hormone testosterone have been found in many girls who take Depakote ER when they're older than about age 10. No symptoms are apparent, but the doctor may want to watch for later problems, perhaps related to weight gain.

A few children who take Depakote ER seem to become more irritable but this is seldom a serious problem.

To reduce side effects, the doctor probably will prescribe a low dose of Depakote ER to start and increase it slowly. Children usually start with a dose of 5 to 10 milligrams (mg) for each kilogram (kg, about 2.2 pounds) of their body weight per day. Since the smallest Depakote ER tablet is 250 milligrams (and it cannot be divided), smaller children may need to begin by using regular Depakote or another valproate medicine. They can switch to Depakote ER when they reach a higher dosage.

Most children do best at about 15 to 60 mg/kg per day. Children taking a combination of Depakote and another seizure medicine usually need the higher doses because of interactions between the medicines.