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Valproic acid therapy inducing absence status evolving into generalized seizures
Eli Shahar1, Jameel Andraus, Tally Sagie-Lerman
1Child Neurology Unit & Epilepsy Service, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
Insights
Valproic acid can rarely trigger absence status and atonic seizures in children with epilepsy. Discontinuing the medication promptly resolves these severe seizure events and disorientation.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Absence epilepsy is a common epilepsy syndrome in children.
- Valproic acid is a widely used antiepileptic drug for various seizure types.
Observation:
- Two children with mild absence epilepsy experienced new-onset absence status epilepticus after initiating valproic acid.
- This progressed to atonic seizures, drop attacks, and disorientation, confirmed by EEG showing generalized spike-wave discharges.
Findings:
- Valproic acid, even at low doses, can induce or worsen absence seizures and atonic seizures in susceptible individuals.
- Abrupt discontinuation of valproic acid led to immediate seizure cessation and cognitive improvement.
Implications:
- Clinicians should consider valproic acid-induced absence status and atonic seizures in pediatric epilepsy management.
- Early recognition and drug withdrawal are crucial for favorable outcomes.
- This highlights the complex and sometimes paradoxical effects of antiepileptic drugs.
Abstract:
The authors herein present two children with mild absence epilepsy, having intermittent absences, who developed absence status evolving into atonic generalized seizures and drop attacks along with progressive disorientation induced by relatively small doses of valproic acid. Consciousness and awareness were intact before the introduction of valproic acid. Both children, after the first dose of valproic acid, developed prolonged and recurrent clusters of absences, which became prolonged, with drop attacks occurring in one patient associated with progressive disorientation. The electroencephalogram concurrently demonstrated prolonged spike-wave discharges, along with disturbance of background activity. Discontinuation of valproic acid resulted in immediate cessation of the prolonged and repetitive clusters of absence episodes and disappearance of drop attacks, along with sensorium clearing. In conclusion, although uncommon, a possible induction of absence status and even atonic seizures by valproic acid should be taken into account and properly managed by abrupt discontinuation of the drug.