Effectiveness of valproic acid on destructive and aggressive behaviours in patients with acquired brain injury

Abstract

Valproic acid, a primary anticonvulsant drug, has recently been studied for purported effectiveness in disparate disorders of mood and behaviour. The psychopharmacological treatment of patients with acquired brain injury frequently includes numerous trials of psychotherapeutic drugs such as antipsychotics, benzodiazepines, antidepressants, and lithium, in an effort towards affective and behavioural improvement. In this report we describe and graphically depict the striking efficacy of valproic acid in reducing and improving destructive and aggressive behaviours in five patients with acquired brain injury. In all cases valproic acid was effective after other pharmacological interventions were not. Also, the addition of valproic acid was followed by neurobehavioural improvement rather quickly, often within 1-2 weeks. Advantages of valproic acid, in addition to its possible unique efficacy, include a lower propensity towards sedation and cognitive impairment, and thus a more robust potential for rehabilitation participation. Behaviours associated with affective disorders ranging along the affective spectrum from depression to dysphoric mania may be particularly amenable to valproic acid. The drug may also be beneficial in some cases in which another psychotropic anticonvulsant, carbamazepine, was not.

Methamphetamine Causes Alterations in the MAP Kinase-Related Pathways in the Brains of Mice that Display Increased Aggressiveness

“…In addition to their use to treat affective disorders, lithium and valporate have been used for the management of aggressive behaviors in various pathological conditions, including mental retardation, brain injury, autism, schizophrenia, attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorder (Bellus et al, 1996;Glenn et al, 1989;Goetzl et al, 1977;Malone et al, 1994;McDougle et al, 2003;Platt et al, 1981;Schiff et al, 1982;Shader et al, 1974;Sheard, 1975Sheard, , 1984Silva et al, 1993;Swann, 2003;Weller et al, 1999;Wroblewski et al, 1997). Lithium has also been reported to block aggressiveness in laboratory animals (Sheard, 1975).…”

Adjunctive Valproic Acid for Delirium and/or Agitation on a Consultation-Liaison Service: A Report of Six Cases

“…In addition, it has been used for other aggressive and agitated states due to central nervous system (CNS) trauma, dementia, and other neurodegenerative disorders. [10][11][12] There have been reports of its utility in the treatment of alcohol withdrawal delirium. 13,14 Because valproic acid may decrease agitated behavior without necessarily decreasing levels of consciousness, it represents an attractive choice for the management of delirium, especially when there are suboptimal response and/or problematic side effects with benzodiazepines and/or antipsychotics.…”

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

“…Divalproex was found to improve agitation in 26 of 29 treated patients within 7 days of a typical 1,250 mg/d dose in a retrospective chart review [126]. Valproic acid was reported to effectively control aggression in five patients in whom other pharmacological interventions had not been effective [127]. Azouvi et al described a series of 10 patients who were treated prospectively with carbamazepine 400 to 800 mg/d for 8 weeks for agitation and anger outbursts at variable intervals post-TBI [86].…”