Abstract
In recent years, the use of valproic acid (VPA) as a mood-stabilizing agent has continuously increased. Although VPA usually is well tolerated, its use in combination with other psychotropic compounds might bear an elevated risk of adverse reactions. Here, we present the case of a 42-year-old male suffering from treatment-resistant psychotic depression, who was prescribed VPA additionally to lithium, clomipramine, flupentixol and risperidone. By doing so, he developed myoclonus, tremor and encephalopathy with sedation and marked EEG background slowing. Most notably, these side effects occurred in the presence of normal VPA and ammonia serum concentrations. On VPA discontinuation, all symptoms vanished and EEG normalized. We thus suggest that direct VPA-induced encephalopathy in the absence of ammonemia does exist, in this case probably facilitated by psychotropic polypharmacy.
References
Oct 1, 1982·Italian Journal of Neurological Sciences·H Gastaut, F Iemolo
Feb 1, 1995·Electroencephalography and Clinical Neurophysiology·U AgugliaA Quattrone
Aug 1, 1994·Journal of Neurology·L Averbuch-HellerA Reches
Sep 1, 1996·Neurology·C ArmonR G Paul
Feb 1, 1997·Therapeutic Drug Monitoring·J C DeToledoR E Ramsay
Aug 5, 2000·Journal of Clinical Psychopharmacology·C FehrN Dahmen
Aug 2, 2000·Journal of Child Neurology·V FarkasC Benninger
Mar 21, 2002·Epilepsia·David G VosslerJohn D Morgan
Sep 25, 2002·CNS Drugs·Emilio Perucca
Apr 4, 2003·International Journal of Geriatric Psychiatry·Andreas ReifBruno Pfuhlmann
Jun 5, 2003·Bipolar Disorders·Charles L Bowden
Citations
Dec 29, 2012·Clinical Rheumatology·Estee Chan, Fiona McQueen
Sep 2, 2009·Case Reports in Medicine·Tina M GardnerRajesh R Tampi
Feb 7, 2012·General Hospital Psychiatry·Amit ChopraMark A Frye
Sep 13, 2011·Journal of Forensic and Legal Medicine·Paula ProençaDuarte Nuno Vieira
Sep 8, 2009·Neurobiology of Disease·Kristen RakSibylle Jablonka
Nov 22, 2007·Annales Françaises D'anesthèsie Et De Rèanimation·P ParizeC Fischer
Jul 31, 2007·Acta Neurologica Scandinavica·S K Velioğlu, S Gazioğlu
Jun 20, 2006·Brain Research Bulletin·Marina Concli LeiteCarlos-Alberto Gonçalves
Oct 1, 2005·Pediatric Neurology·Mona Sazgar, Blaise F D Bourgeois
Jun 22, 2006·Seizure : the Journal of the British Epilepsy Association·Thorsten GerstnerStephan A Koenig
Jan 26, 2010·Journal of Psychiatric Practice·Miroslav CuturicJames W Hardin
Aug 14, 2008·CNS Drugs·Gina M Kennedy, Samden D Lhatoo
Oct 6, 2007·International Clinical Psychopharmacology·Marie-José C C Dealberto
Oct 5, 2021·Prague Medical Report·Jamir Pitton RissardoÍcaro Durante