Impairment of consciousness induced by valproate treatment following neurosurgical operation

Acta neurochirurgica
J LandauJ Philippon

Abstract

Eight patients, who underwent neurosurgery for various supratentorial lesions presented unexplained impairment of consciousness during the first post-operative days. These states ranged from stupor to deep coma, and two patients had an emergency re-exploration. All these patients were receiving the usual dosage (1000 to 1500 mg per day) of Valproic acid (VPA). The treatment had been initiated either several weeks or months previously in 4 cases, and was thus well tolerated, or the day before surgery in the 4 other cases. EEG recordings displayed diffuse abnormalities, delta waves and/or high voltage triphasic complexes, that led to the diagnosis of VPA intolerance and drug withdrawal. Then full clinical recovery and EEG clearing occurred within 1 to 5 days. VPA intolerances are wellknown but remain exceptional, about 1 case per 100.000. In our neurosurgical population, however, the rate was higher, approximately 2%. Wide areas of blood brain barrier destruction may contribute to the higher frequency of this easily reversible cause of post-operative stupor or coma.

References

Dec 1, 1979·Annals of Neurology·D W ChadwickN E Cartlidge
Jun 25, 1977·British Medical Journal·M H Bellmann, E M Ross
Oct 1, 1979·Neurology·M Koskiniemi, L Hakamies
Oct 1, 1990·Archives of Neurology·W J TriggsL J Willmore
Sep 1, 1981·Neurology·S RawatH M Swick

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