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Related Concept Videos

Antiepileptic Drugs: Glutamate Antagonists01:14

Antiepileptic Drugs: Glutamate Antagonists

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Glutamate is a fundamental neurotransmitter in the central nervous system, playing a vital role in neuronal communication and various cognitive processes. Glutamate stands as the principal excitatory neurotransmitter in the brain. Its presence is crucial for the communication between neurons, underpinning essential processes such as synaptic transmission, neuronal excitability, and plasticity. These functions are vital for higher-order cognitive processes, including learning and memory. The...
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Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.     
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Antiepileptic drugs, such as levetiracetam (Keppra) and brivaracetam (Briviact), have emerged as crucial tools in managing epilepsy. These medications exert their therapeutic effects by targeting the synaptic vesicle protein SV2A, a transmembrane glycoprotein primarily found in the brain.
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Antiepileptic Drugs: Potassium Channel Activators01:20

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Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
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Phenylketonuria (PKU) is a protein metabolism disorder characterized by high blood levels of the amino acid phenylalanine. This results from a mutation in the gene responsible for phenylalanine hydroxylase, an enzyme that converts phenylalanine into tyrosine. When this enzyme is deficient, phenylalanine builds up in the blood, leading to symptoms such as vomiting, rashes, seizures, growth deficiency, and severe mental retardation. An early diagnosis and a diet restricting phenylalanine intake...
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Valproate-induced hyperammonemic encephalopathy: a case report.

Suhal Shah1, Richard Wang2, Ulrick Vieux2

  • 1Orange Regional Medical Center, Middletown, NY, USA. sshah1@ghvhs.org.

Journal of Medical Case Reports
|January 26, 2020
PubMed
Summary
This summary is machine-generated.

Valproate can cause a rare but serious condition called hyperammonemic encephalopathy. Promptly recognizing and treating this reaction, as shown in this case, leads to a full recovery.

Keywords:
HyperammonemiaValproateValproic acid

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Toxicology

Background:

  • Hyperammonemic encephalopathy is a rare, severe adverse reaction linked to valproate medication.
  • The precise mechanism of valproate-induced hyperammonemic encephalopathy remains unclear, with limited established treatment guidelines.
  • This case report addresses current knowledge gaps and research needs concerning this condition.

Observation:

  • A 57-year-old woman with bipolar I disorder and substance use disorders developed altered mental status, confusion, and ataxia after initiating valproate.
  • Elevated ammonia levels were detected, prompting discontinuation of valproate and initiation of lactulose.
  • The patient's mental status improved significantly within 48 hours of intervention.

Findings:

  • The patient was diagnosed with valproate-induced hyperammonemic encephalopathy, a rare and reversible adverse effect.
  • Rapid identification and management, including medication adjustment and lactulose, were crucial for recovery.
  • This case underscores the importance of monitoring ammonia levels in patients exhibiting neurological symptoms while on valproate.

Implications:

  • Early recognition of valproate-induced hyperammonemic encephalopathy is vital for favorable patient outcomes.
  • Further research is needed to elucidate the exact mechanism of action and establish definitive treatment protocols.
  • This case contributes to the understanding of managing this rare but serious complication of valproate therapy.