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Asterixis associated with sodium valproate.

J B Bodensteiner, H H Morris, G S Golden

    Neurology
    |February 1, 1981
    PubMed
    Summary
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    Asterixis, a neurological symptom, can occur with valproic acid even at normal levels. This finding suggests a central nervous system effect unrelated to liver damage or sedation.

    Area of Science:

    • Neurology
    • Pharmacology

    Background:

    • Asterixis is a motor disorder characterized by irregular flaps, often associated with metabolic encephalopathies or drug toxicity.
    • While intoxication with many anticonvulsants can cause asterixis, it typically occurs at serum levels exceeding the therapeutic range.

    Observation:

    • This report details two patients experiencing asterixis while on valproic acid therapy.
    • Both patients maintained serum valproic acid levels within the established therapeutic range.
    • Neither patient exhibited signs of hepatotoxicity or significant sedation.

    Findings:

    • Valproic acid can induce asterixis even when serum concentrations are therapeutic.
    • This association is rare, with only one prior reported case.
    • The mechanism appears to be a direct central nervous system effect of valproic acid, independent of hepatotoxicity or sedation.

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    Implications:

    • Clinicians should consider valproic acid-induced asterixis in patients presenting with this symptom, even with normal drug levels.
    • This highlights a potential central neurological side effect of valproic acid that warrants further investigation.
    • Further research is needed to elucidate the precise central mechanism underlying valproate-associated asterixis.