Lethal obesity associated with sodium valproate in a brain-injured patient.
A 34-year-old man developed posttraumatic epilepsy and a disinhibited orbitofrontal syndrome following severe head trauma at age 22. After an 11-year prison term marked by repeated impulsive aggression, he was transferred to a state psychiatric hospital. Replacement of phenytoin by valproic acid resulted in a 100-lb weight gain, exacerbation of sleep apnea, and right heart failure. Despite replacement of valproate with topiramate, he died of a cardiorespiratory arrest during a seizure. This case illustrates the potential risks associated with valproate therapy in the obese brain-damaged population.
Black
Deborah N
DN
Department of Neurology, University of Vermont, Burlington, Vermont, USA. dnblack@globalnetisp.net
Althoff
Robert R
RR
Daye
Kathleen
K
Pelletier
Corinne A
CA
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D004827:Epilepsy / Q000209:etiology*; D017809:Fatal Outcome; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000139:chemically induced*; D012891:Sleep Apnea Syndromes / Q000209:etiology; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use*
D000927:Anticonvulsants; D014635:Valproic Acid