Impairment of consciousness induced by valproate treatment following neurosurgical operation.
Eight patients, who underwent neurosurgery for various supratentorial lesions presented unexplained impairment of consciousness during the first post-operative days. These states ranged from stupor to deep coma, and two patients had an emergency re-exploration. All these patients were receiving the usual dosage (1000 to 1500 mg per day) of Valproic acid (VPA). The treatment had been initiated either several weeks or months previously in 4 cases, and was thus well tolerated, or the day before surgery in the 4 other cases. EEG recordings displayed diffuse abnormalities, delta waves and/or high voltage triphasic complexes, that led to the diagnosis of VPA intolerance and drug withdrawal. Then full clinical recovery and EEG clearing occurred within 1 to 5 days. VPA intolerances are wellknown but remain exceptional, about 1 case per 100.000. In our neurosurgical population, however, the rate was higher, approximately 2%. Wide areas of blood brain barrier destruction may contribute to the higher frequency of this easily reversible cause of post-operative stupor or coma.
Landau
J
J
Service d'Explorations Fonctionnelles du Système Nerveux, Hôpital de la Salpêtriêre, Paris, France.
Baulac
M
M
Durand
G
G
de Billy
A
A
Philippon
J
J
D000293:Adolescent; D000328:Adult; D001143:Arousal / Q000187:drug effects; D001932:Brain Neoplasms / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000601:surgery*; D003128:Coma / Q000139:chemically induced; D003244:Consciousness Disorders / Q000139:chemically induced*; D003700:Delta Rhythm; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects*; D004827:Epilepsy / Q000601:surgery; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D012086:Reoperation; D015173:Supratentorial Neoplasms / Q000601:surgery; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
D014635:Valproic Acid