Valproate-induced Encephalopathy: A Depiction of Symptoms on the Basis of a Case Report

We report a 62 year old patient with an aquainted bipolar disorder under long-term medication with lithium, amitryptiline and levothyroxine who developed a accumulatively deficit in propulsion and loss of dynamism, so that citalopram and valproate were added to current remedy. 15 days after subjoining valproate she developed an impairment in her ability to concentrate, perceptivity and memory, a faded diction, mild confusion and instability of gait – appearing as a dementing disorder. After stopping the valproate due to an assumed emerging encephalopathy, symptoms resolved within 3 weeks.

Independent of valproate serum levels and at regular liver function tests alterations in consciousness and focal neurological symptoms represent the leading clinical symptoms of valproate encephalopathy. Elevated serum ammonium and carnitine levels and increased serum or CSF (cerebrospinal fluid) glutamine production in plasma and liquor support the diagnosis. Liquor occasionally shows unspecific elevation of total protein. EEG (electroencephalography)-findings are not always typical for encephalopathy whereas MRI (magnetic resonance imaging) and MRS (MR spectroscopy) can usually reveal a metabolic-toxic lesions pattern analogical to hepatic encephalopathy. The risk for developing encephalopathy can be incremented by rapid initial augmentation of valproate or pre-existing lesions of the nervous system. After going off the drug clinical symptoms can disappear within a few weeks or months without any specific therapy.

Application of valproate as a widely used and for a long time inaugurated drug heightens the jeopardy to overlook the rare but potentially life-threatening though reversible side-effect of encephalopathy. Our intention it to sharpen the sensitivity for this.

Valproate is a known, widely used and generally well tolerated drug. Hence we hope to sharpen the sensitivity to discern the jeopardy to overlook an encephalopathy as a rare but potentially life-threatening though reversible side-effect.