title: Divergence Palsy due to Divalproex and Oxcarbazepine.
abstract: OBJECTIVE
  This case series is the first to describe divergence palsy as an adverse effect of antiepileptic drug use. Diplopia is a common adverse effect of antiepileptic drugs, but no explanatory motility deficit has ever been reported.
  
  
  METHODS
  We present 2 patients, 1 on oxcarbazepine and 1 on divalproex, each with a normal examination result between spells and divergency palsy when symptomatic.
  
  
  RESULTS
  Discontinuation of the antiepileptic medication led to resolution of the episodes in both cases. Rechallenge with the offending agent after washout in one patient resulted in recurrence of diplopia and divergence palsy, both resolving after subsequent withdrawal of the antiepileptic.
  
  
  CONCLUSIONS
  Antiepileptic drugs may cause divergence palsy.
authors.affiliation: *Department of Ophthalmology, Division of Neuro-Ophthalmology, Massachusetts Eye and Ear Infirmary; †Department of Neurology; and ‡Department of Surgery, Division of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Marc Albert
authors.initials: MA
authors.lastname: Bouffard
authors.forename: Louis R
authors.initials: LR
authors.lastname: Caplan
authors.forename: Nurhan
authors.initials: N
authors.lastname: Torun
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D002220:Carbamazepine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004172:Diplopia / Q000209:etiology / Q000517:prevention & control; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015840:Oculomotor Nerve Diseases / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D000078330:Oxcarbazepine; D016896:Treatment Outcome; D014635:Valproic Acid / Q000009:adverse effects*
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D000078330:Oxcarbazepine