Valproate-related hyperammonemic encephalopathy with generalized suppression EEG: a case report

作者全名："Liu, Xianyun; Peng, Xi"

作者地址："[Liu, Xianyun; Peng, Xi] Chongqing Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China"

通信作者："Peng, X (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China."

来源：NEUROLOGICAL SCIENCES

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000995955700001

JCR分区：Q2

影响因子：3.3

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Hyperammonemia; Hyperammonemic encephalopathy; Valproic acid; Generalized suppression EEG

摘要："BackgroundValproic acid (VPA) is a prevalent antiseizure medication (ASM) used to treat epilepsy. Valproate-related hyperammonemic encephalopathy (VHE) is a type of encephalopathy that can occur during neurocritical situations. In VHE, the electroencephalogram (EEG) displays diffuse slow waves or periodic waves, and there is no generalized suppression pattern.Case presentationWe present a case of a 29-year-old female with a history of epilepsy who was admitted for convulsive status epilepticus (CSE), which was controlled by intravenous VPA, as well as oral VPA and phenytoin. The patient did not experience further convulsions but instead developed impaired consciousness. Continuous EEG monitoring revealed a generalized suppression pattern, and the patient was unresponsive. The patient's blood ammonia level was significantly elevated at 386.8 mu mol/L, indicating VHE. Additionally, the patient's serum VPA level was 58.37 mu g/ml (normal range: 50-100 mu g/ml). After stopping VPA and phenytoin and transitioning to oxcarbazepine for anti-seizure and symptomatic treatment, the patient's EEG gradually returned to normal, and her consciousness was fully restored.DiscussionVHE can cause the EEG to display a generalized suppression pattern. It is crucial to recognize this specific situation and not to infer a poor prognosis based on this EEG pattern."

基金机构：KuanRen Outstanding Young Talent Program of the Second. Affiliated Hospital of Chongqing Medical University [KY2019Y006]

基金资助正文：This study was funded by KuanRen Outstanding Young Talent Program of the Second. Affiliated Hospital of Chongqing Medical University (KY2019Y006).