Case Report
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A Case of Valproic Acid-Associated Encephalopathy without Hyperammonemia

Year 2019, Volume: 6 Issue: 3, 160 - 162, 31.12.2019

Abstract

   Valproic acid is a branched-chain carboxylic acid construct used as an
antiepileptic agent. Side effects can be listed as nausea, vomiting, alopecia,
weight gain, asymptomatic increase in liver function tests, fulminant hepatitis,
sedation, ataxia, tremor, pancreatitis, cardiac arrhythmia, thrombocytopenia,
hyperammonemia and encephalopathy. Valproate-associated encephalopathy is often
characterized by impairment in change of consciousness, apathy, irritability,
confusion, and impaired liver function. This table is accompanied with a high
level of ammonia in the blood. Rarely, encephalopathy may occur without
hyperammonemia and irrespective of serum valproate level. Typical clinical
findings in this case report were supported by EEG records and serum ammonia
level was found to be normal in our patient. Valproate Encephalopathy without
Hyperammonemia was diagnosed. Clinical improvement after cessation of valproate
treatment was also demonstrated by EEG findings and the diagnosis was
supported.

References

  • 1. Perucca E. Pharmacological and therapeutic properties of valproate. Cns Drugs. 2002;16(10):695–714.
  • 2. Blackford MG, Do ST, Enlow TC, Reed MD. Valproic acid and topiramate ınduced hyperammonemic encephalopathy in a patient with normal serum carnitine. J Pediatr Pharmacol Ther. 2013;18(2):128–36.
  • 3. Twilla JD, Pierce AS. Hyperammonemic encephalopathy due to valproic acid and topiramate interaction. Case Rep Psychiatry. 2014;2014:410403.
  • 4. Moore K, Dixit D, Wagner M. Topiramate-related hyperammonemia. J Pharm Technol. 2016;32(1):34– 6.
  • 5. Sin O, Batterink J. Encephalopathy induced by combination theraphy with valproic acid and topiramate: challenging the utility of serum ammonia measurement. Can J Hosp Pharm. 2015;68(1):54-6.
  • 6. Chopra A, Kolla BP, Mansukhani MP, Netzel P, Frye MA. Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management. Gen Hosp Psychiatry. 2012;34(3):290-8.
  • 7. Raja M, Azzoni A. Valproate-induced hyperammonaemia. J Clin Psychopharmacol. 2002;22(6):631-3.
  • 8. Hamer HM, Knake S, Schomburg U, Rosenow F. Valproate-induced hyperammonemic encephalopathy in the presence of topiramate. Neurology. 2000;54(1):230–2.
  • 9. Deutsch SI, Burket JA, Rosse RB. Valproate-induced hyperammonemic encephalopathy and normal liver functions: possible synergism with topiramate. Clin Neuropharmacol. 2009;32(6):350-2.
  • 10. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.
  • 11. Shapira Y, Gutman A. Muscle carnitine deficiency in patients using valproic acid. J Pediatr. 1991;118(4 pt 1):646-9.

Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu

Year 2019, Volume: 6 Issue: 3, 160 - 162, 31.12.2019

Abstract

Valproik asit antiepileptik ajan olarak
kullanılan dallı zincirli karboksilik asit yapısında bir ajandır. 
Yan etkileri; bulantı, kusma, alopesi, kilo
alımı, asemptomatik olarak karaciğer fonksiyon testlerinde artış, fulminan
hepatit, sedasyon, ataksi, tremor, pankreatit, kardiyak aritmi, trombositopeni,
hiperammonemi ve ensefalopati tablosu olarak sıralanabilir. Valproat ile
ilişkili ensefalopati sıklıkla bilinç durumunda bozulma, apati, sinirlilik,
konfüzyon, karaciğer fonksiyonlarında bozulma ile karakterize bir tablodur. Bu
tabloya kan amonyak düzeyinde yükseklik sıklıkla eşlik eder. Daha nadir olarak
ise hiperammonemi görülmeden ve serum valproat düzeyine bağlı olmaksızın da
ensefalopati tablosu ortaya çıkabilir. Bildirmiş olduğumuz bu olguda tipik
klinik bulgular; EEG kayıtları ile desteklenmiş, hastamızda serum amonyak
düzeyi normal bulunmuştur ve Hiperammonemi olmaksızın Valproat Ensefalopatisi
tanısına ulaşılmıştır. Sonrasında valproat tedavisinin kesilmesinin ardından
görülen klinik iyileşme, yine EEG bulgularıyla da ortaya konmuş, tanı
desteklenmiştir.



References

  • 1. Perucca E. Pharmacological and therapeutic properties of valproate. Cns Drugs. 2002;16(10):695–714.
  • 2. Blackford MG, Do ST, Enlow TC, Reed MD. Valproic acid and topiramate ınduced hyperammonemic encephalopathy in a patient with normal serum carnitine. J Pediatr Pharmacol Ther. 2013;18(2):128–36.
  • 3. Twilla JD, Pierce AS. Hyperammonemic encephalopathy due to valproic acid and topiramate interaction. Case Rep Psychiatry. 2014;2014:410403.
  • 4. Moore K, Dixit D, Wagner M. Topiramate-related hyperammonemia. J Pharm Technol. 2016;32(1):34– 6.
  • 5. Sin O, Batterink J. Encephalopathy induced by combination theraphy with valproic acid and topiramate: challenging the utility of serum ammonia measurement. Can J Hosp Pharm. 2015;68(1):54-6.
  • 6. Chopra A, Kolla BP, Mansukhani MP, Netzel P, Frye MA. Valproate-induced hyperammonemic encephalopathy: an update on risk factors, clinical correlates and management. Gen Hosp Psychiatry. 2012;34(3):290-8.
  • 7. Raja M, Azzoni A. Valproate-induced hyperammonaemia. J Clin Psychopharmacol. 2002;22(6):631-3.
  • 8. Hamer HM, Knake S, Schomburg U, Rosenow F. Valproate-induced hyperammonemic encephalopathy in the presence of topiramate. Neurology. 2000;54(1):230–2.
  • 9. Deutsch SI, Burket JA, Rosse RB. Valproate-induced hyperammonemic encephalopathy and normal liver functions: possible synergism with topiramate. Clin Neuropharmacol. 2009;32(6):350-2.
  • 10. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45.
  • 11. Shapira Y, Gutman A. Muscle carnitine deficiency in patients using valproic acid. J Pediatr. 1991;118(4 pt 1):646-9.
There are 11 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section Case Report
Authors

MAHMUT BİLAL Çaman 0000-0001-7956-5677

Ayşe Özlem Akgün This is me 0000-0001-8328-3701

Semai Bek 0000-0003-4913-976X

Gülnihal Kutlu 0000-0002-9325-4151

Publication Date December 31, 2019
Submission Date February 22, 2019
Published in Issue Year 2019 Volume: 6 Issue: 3

Cite

APA Çaman, M. B., Akgün, A. Ö., Bek, S., Kutlu, G. (2019). Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 6(3), 160-162.
AMA Çaman MB, Akgün AÖ, Bek S, Kutlu G. Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu. MMJ. December 2019;6(3):160-162.
Chicago Çaman, MAHMUT BİLAL, Ayşe Özlem Akgün, Semai Bek, and Gülnihal Kutlu. “Hiperammonemi Olmaksızın Valproik Asit Ile İlişkili Ensefalopati Olgusu”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 6, no. 3 (December 2019): 160-62.
EndNote Çaman MB, Akgün AÖ, Bek S, Kutlu G (December 1, 2019) Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 6 3 160–162.
IEEE M. B. Çaman, A. Ö. Akgün, S. Bek, and G. Kutlu, “Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu”, MMJ, vol. 6, no. 3, pp. 160–162, 2019.
ISNAD Çaman, MAHMUT BİLAL et al. “Hiperammonemi Olmaksızın Valproik Asit Ile İlişkili Ensefalopati Olgusu”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 6/3 (December 2019), 160-162.
JAMA Çaman MB, Akgün AÖ, Bek S, Kutlu G. Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu. MMJ. 2019;6:160–162.
MLA Çaman, MAHMUT BİLAL et al. “Hiperammonemi Olmaksızın Valproik Asit Ile İlişkili Ensefalopati Olgusu”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 6, no. 3, 2019, pp. 160-2.
Vancouver Çaman MB, Akgün AÖ, Bek S, Kutlu G. Hiperammonemi Olmaksızın Valproik Asit ile İlişkili Ensefalopati Olgusu. MMJ. 2019;6(3):160-2.