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Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy
Authors:Velioğlu S K  Gazioğlu S
Affiliation:Karadeniz Technical University Medical Faculty, Trabzon, Turkey. sveli@meds.ktu.edu.tr
Abstract:BACKGROUND: Valproic acid (VPA) may induce hyperammonemic encephalopathy. On the other hand, seizure-inducing effects of antiepileptic drugs (AEDs) may be a paradoxical reaction or a result of AED-induced encephalopathy (commonly induced by VPA). METHODS: We present the case of a 19-year-old male who developed acute mental status changes consistent with encephalopathy evolving into repetitive seizures with oral automatisms induced by relatively small doses of VPA. RESULTS: Although serum hepatic enzymes, such as AST and ALT, were normal, serum ammonia concentration was high, i.e. 70 micromol/l (normal range 9-33 micromol/l). Administration of VPA was discontinued immediately after admission. The patient's condition improved during the second week of hospitalization and ammonium levels returned to normal. CONCLUSION: In conclusion, although uncommon, a possible induction of non-convulsive status epilepticus by valproate-induced hyperammonemic encephalopathy should be taken into account and properly managed by discontinuation of the drug.
Keywords:EEG  encephalopathy  hypermmonemia  non-convulsive status epilepticus  valproic acid  adverse effects  antiepileptic drugs  seizures
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