Göbel R, Görtzen A, Bräunig P
Westfälisches Zentrum für Psychiatrie und Psychotherapie Bochum-Universitätsklinik.
Fortschr Neurol Psychiatr. 1999 Jan;67(1):7-11. doi: 10.1055/s-2007-993732.
Valproic acid (VPA)-induced encephalopathy is a rarely considered side effect, with somnolence, reduced motor activity and severe deterioration of cognitive and behavioural abilities. In accordance with the increasing clinical importance of valproate clinical symptoms, causes and possibilities of treatment are reviewed by reporting on two cases of valproate-induced encephalopathy. In comparison to VPA intoxication, which is associated to increased VPA blood levels, the mechanisms of encephalopathy may include interactions of the hepatic enzymes, a direct toxic effect on the cerebral receptors, as well as drug interactions, a paradoxical epileptogenic effect and metabolic interactions. In most cases withdrawal of VPA produces regression of the symptoms within a few days; the role of L-carnitin or citrullin supplementation in clinical treatment remains unclear.
丙戊酸（VPA）诱发的脑病是一种很少被考虑到的副作用，表现为嗜睡、运动活动减少以及认知和行为能力严重衰退。鉴于丙戊酸盐临床症状、病因及治疗可能性的临床重要性日益增加，本文通过报告两例丙戊酸诱发的脑病病例，对其进行综述。与VPA中毒（与VPA血药浓度升高相关）相比，脑病的机制可能包括肝酶相互作用、对脑受体的直接毒性作用、药物相互作用、反常的致痫作用以及代谢相互作用。在大多数情况下，停用VPA几天后症状会消退；补充L-肉碱或瓜氨酸在临床治疗中的作用仍不明确。
