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Lethal obesity associated with sodium valproate in a brain-injured patient
Deborah N Black1, Robert R Althoff, Kathleen Daye
1Department of Neurology, University of Vermont, Burlington, Vermont, USA. dnblack@globalnetisp.net
Abstract:
A 34-year-old man developed posttraumatic epilepsy and a disinhibited orbitofrontal syndrome following severe head trauma at age 22. After an 11-year prison term marked by repeated impulsive aggression, he was transferred to a state psychiatric hospital. Replacement of phenytoin by valproic acid resulted in a 100-lb weight gain, exacerbation of sleep apnea, and right heart failure. Despite replacement of valproate with topiramate, he died of a cardiorespiratory arrest during a seizure. This case illustrates the potential risks associated with valproate therapy in the obese brain-damaged population.
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