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Reversible dementia and apparent brain atrophy during valproate therapy
O Papazian1, E Cañizales, I Alfonso
1Department of Neurology, Miami Children's Hospital, Miami, FL, USA.
Annals of Neurology
|October 1, 1995
Summary
Sodium valproate, used for epilepsy, may cause severe cognitive and behavioral decline in children. Discontinuing this medication can reverse these neurological and imaging abnormalities.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuropharmacology
Background:
- Sodium valproate is a common antiepileptic drug.
- Idiopathic, localization-related epilepsy with centrotemporal spikes is a specific epilepsy syndrome.
- Severe cognitive and behavioral deterioration can mimic degenerative diseases in children.
Purpose of the Study:
- To report a rare adverse effect of sodium valproate therapy.
- To highlight the potential for neurotoxicity associated with valproate.
- To advocate for prompt withdrawal of valproate in cases of unexplained neurological decline.
Main Methods:
- Case study of two pediatric patients treated with sodium valproate.
- Clinical assessment of cognitive and behavioral symptoms.
- Magnetic resonance imaging (MRI) to evaluate brain structure.
- Monitoring of symptoms and imaging after drug withdrawal.
Main Results:
- Both patients experienced severe cognitive and behavioral deterioration.
- MRI revealed significant cortical and cerebellar atrophy.
- Symptoms and MRI abnormalities resolved after discontinuing sodium valproate.
- No underlying metabolic disorders were identified.
Conclusions:
- Sodium valproate can cause severe, reversible neurotoxicity in children.
- Valproate withdrawal is recommended for epileptic patients with unexplained neuromental deterioration or brain atrophy.
- The mechanism of this idiosyncratic reaction remains unknown.