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Valproate-induced hyperammonemic encephalopathy in neurosurgical patients: Our experience and systematic literature review.
Neurosurg Rev
November 2024
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Article Synopsis
- Sodium valproate is commonly used to treat seizures, chronic pain, and bipolar disorder, but it can cause severe side effects like valproate-induced hyperammonemic encephalopathy (VHE), which is life-threatening.
- A study reviewed four neurosurgical patients who developed VHE after using valproate for seizure prevention, revealing a 50% mortality rate and indicating that prompt diagnosis and treatment are crucial.
- Treatment involved discontinuing valproate and, in some cases, dialysis; half of the patients experienced clinical improvement after normalization of ammonia levels.
Sodium Valproate-Induced Hyperammonemia: A Case Series in a Tertiary Care Hospital.
Cureus
July 2024
Pharmacology, Christian Medical College and Hospital, Ludhiana, IND.
Background: Sodium valproate (VPA) is an extensively used anti-convulsant, which is an effective drug for treatment of epilepsy in adults and children, as well as for conditions like migraine, bipolar disorder, mania, and trigeminal neuralgia. Sedation, vertigo, ataxia, dose-dependent tremors, headaches, and gastrointestinal side effects are the most often reported adverse effects associated with VPA. A potential life-threatening event reported with VPA is hyperammonemia (HA), which is defined as an increase in serum level of ammonia.
View Article and Find Full Text PDFValproate, risperidone, and paliperidone: A case of valproate-induced hyperammonemic encephalopathy.
Ment Health Clin
February 2024
Medical Director, McNew Medical Center, Chief of Psychiatry, Behavioral Health, Luminis Health, Annapolis, Maryland.
Article Synopsis
- Hyperammonemia can occur as a side effect of valproate, leading to a serious condition called valproate-induced hyperammonemic encephalopathy (VHE), especially when used with other antiepileptic drugs.
- A case involving a 20-year-old male with bipolar disorder highlights the risks of VHE when valproate is combined with risperidone and paliperidone palmitate.
- After starting treatment with these medications, the patient experienced severe symptoms including drowsiness and vomiting, which led to a diagnosis of hyperammonemia and a transfer to the emergency department for urgent care.
Mitochondrial targets in hyperammonemia: Addressing urea cycle function to improve drug therapies.
Biochem Pharmacol
April 2024
Research Institute for Medicines-iMed.ULisboa, Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal. Electronic address:
Article Synopsis
- The urea cycle is a vital process in the liver that disposes of nitrogen waste from amino acid breakdown, and its dysfunction can lead to serious health issues.
- Urea cycle disorders (UCD) and certain rare diseases can cause hyperammonemia (excess ammonia in the blood), which may result from genetic defects or drugs like antiepileptics and specific chemotherapy agents.
- This review highlights biochemical mechanisms behind hyperammonemia and emphasizes the need to study genetic mutations in patients taking these medications to prevent ammonia-related complications.
Valproate-induced hyperammonemia, neuroleptic sensitivity, and cerebellar atrophy-A clinical conundrum in the management of bipolar disorder.
Bipolar Disord
March 2024
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
Objective: Treatment of bipolar disorder (BD) involves complexities especially when patients come with significant sensitivity to various psychotropic medications and comorbidities. The following cases aim to recapitulate and discuss some of such situations.
Cases: Case 1: A 36-year-old man with intellectual development disorder and BD experienced catatonia, seizures, and hyperammonemia following valproate administration.
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