Valproic-induced Hyperammonemic Encephalopathy in a Known Case of Epilepsy

Imam, Syed F; Lodhi, Omair Ul Haq; Zafar, Rizwan; S, Nasim; Malik, Waseem T

doi:10.7759/cureus.1557

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Manual search of reference lists and gray literature did not identify additional studies. After screening and assessing for eligibility, 240 studies were included with the remaining articles being excluded for meeting the exclusion criteria 6,7,12–245 . Among the excluded 350 articles, 37 were literature reviews, 5 were pharmacokinetically related, 41 were VPA overdose related, and 267 articles were unable to clearly answer our objectives listed.…”

Section: Resultsmentioning

confidence: 99%

Valproic Acid–Associated Hyperammonemia

Wong

Fan

Wan

et al. 2023

J Clin Psychopharmacol

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BackgroundHyperammonemia is an adverse effect that poses clinical uncertainty around valproic acid (VPA) use. The prevalence of symptomatic and asymptomatic hyperammonemia and its relationship to VPA concentration is not well established. There is also no clear guidance regarding its management. This results in variability in the monitoring and treatment of VPA–induced hyperammonemia. To inform clinical practice, this systematic review aims to summarize evidence available around VPA-associated hyperammonemia and its prevalence, clinical outcomes, and management.MethodsAn electronic search was performed through Ovid MEDLINE, Ovid Embase, Web of Science, and PsycINFO using search terms that identified hyperammonemia in patients receiving VPA. Two reviewers independently performed primary title and abstract screening with a third reviewer resolving conflicting screening results. This process was repeated during the full-text review process.ResultsA total of 240 articles were included. Prevalence of asymptomatic hyperammonemia (5%–73%) was higher than symptomatic hyperammonemia (0.7%–22.2%) and occurred within the therapeutic range of VPA serum concentration. Various risk factors were identified, including concomitant medications, liver injury, and defects in carnitine metabolism. With VPA discontinued, most symptomatic patients returned to baseline mental status with normalized ammonia level. There was insufficient data to support routine monitoring of ammonia level for VPA-associated hyperammonemia.ConclusionsValproic acid–associated hyperammonemia is a common adverse effect that may occur within therapeutic range of VPA. Further studies are required to determine the benefit of routine ammonia level monitoring and to guide the management of VPA-associated hyperammonemia.

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Section: Resultsmentioning

confidence: 99%

Valproic Acid–Associated Hyperammonemia

Wong

Fan

Wan

et al. 2023

J Clin Psychopharmacol

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“…Suas brácteas são grandes, 15-20 cm de comprimento, de formato ovalado e coloração vermelho-escuro, atuando na proteção do desenvolvimento das flores que originam o fruto (IMAM; AKTER, 2011;AJIJOLAKEWU et al, 2021). Produz frutos grandes e carnosos, portadores de muitos nutrientes, que são usados na alimentação de milhões de pessoas no mundo inteiro (ANDRADE, 2007;IMAM;AKTER, 2011;AJIJOLAKEWU et al, 2021).…”

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Avaliação da atividade antimicrobiana do extrato etanólico das brácteas de <em>Musa x paradisíaca</em> L

Silva¹,

Santana²,

Lopes³

et al. 2023

Braz. J. Hea. Rev.

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Musa x paradisíaca L, conhecida popularmente como bananeira, é uma planta herbácea, nativa da Ásia, extensamente cultivada nos países tropicais. Seus órgãos contém várias classes de fitoquímicos, incluindo taninos, fenóis, flavonóides, alcalóides e saponinas. E já comprovou-se que a espécie possui diversas propriedades farmacológicas, tais como antimicrobiana, antidiarreica e cicatrizante. Visto isso, o objetivo deste trabalho foi investigar a atividade antimicrobiana do extrato etanólico das brácteas de M. paradisiaca sobre bactérias e leveduras patogênicas. Para isso utilizou-se o método de microdiluição em caldo em placa de 96 poços. Desse modo, verificou-se que o extrato apresentou ação contra todos os microrganismos testados, sendo eles as bactérias Gram positivas Staphylococcus aureus e Staphylococcus epidermidis, as Gram negativas Pseudomonas aeruginosas e Escherichia coli, e as leveduras Candida albicans, Candida parapsilosis , Candida krusei e Candida glabrata.

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Hyperammonaemia and Cognitive Impairment in Epilepsy Patients Treated With Valproic Acid – Preliminary Study

Szczygieł-Pilut

Zajączkowska-Dutkiewicz

Pilut³

et al. 2022

Wiad Lek

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The aim: To determine whether VPA pharmacotherapy, mainly in the group of patients using subtherapeutic doses of VPA, could contribute to the occurrence of cognitive impairment. Materials and methods: The study involved 14 patients: six women and eight men, aged 24 - 77 years (mean SD ± - 52.36±13.71) diagnosed with epilepsy in accordance with the ILAE criteria (International League Against Epilepsy), in whom the main clinical complaint, in addition to poor control of epileptic seizures, were impaired concentration, attention and memory impairment. Results: Mild cognitive impairment - MCI was diagnosed in 4 patients (28.57%) (3 with elevated ammonia levels, 1 without), in 1 patient (7.14%) there was a mild level of dementia. In only one MCI case, elevated serum concentrations of valproic acid were also recorded. It is very important to highlight that cognitive impairment has never been diagnosed before (prior to VPA therapy) in this group. Of these 5 patients, in four cases, after discontinuation of the drug, an improvement in the clinical condition was achieved. In a patient with mild level dementia, the termination of therapy did not give a similar effect. This proves the possibility of other mechanisms responsible for generating these sometimes irreversible disorders. Conclusions: Regardless of the dose and concentration of ammonia in blood serum of patients diagnosed with epilepsy, VPA therapy may cause various, significant dysfunctions that significantly impair quality of life.

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Valproic-induced Hyperammonemic Encephalopathy in a Known Case of Epilepsy

Cited by 4 publications

References 7 publications

Valproic Acid–Associated Hyperammonemia

Valproic Acid–Associated Hyperammonemia

Avaliação da atividade antimicrobiana do extrato etanólico das brácteas de <em>Musa x paradisíaca</em> L

Hyperammonaemia and Cognitive Impairment in Epilepsy Patients Treated With Valproic Acid – Preliminary Study

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