Reif Andreas, Leonhard Christine, Mössner Rainald, Lesch Klaus-Peter, Fallgatter Andreas J
Department of Psychiatry, Julius-Maximilians-University of Würzburg, Füchsleinstr. 15, D-97080 Würzburg, Germany.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Sep;28(6):1061-3. doi: 10.1016/j.pnpbp.2004.05.041.
In recent years, the use of valproic acid (VPA) as a mood-stabilizing agent has continuously increased. Although VPA usually is well tolerated, its use in combination with other psychotropic compounds might bear an elevated risk of adverse reactions. Here, we present the case of a 42-year-old male suffering from treatment-resistant psychotic depression, who was prescribed VPA additionally to lithium, clomipramine, flupentixol and risperidone. By doing so, he developed myoclonus, tremor and encephalopathy with sedation and marked EEG background slowing. Most notably, these side effects occurred in the presence of normal VPA and ammonia serum concentrations. On VPA discontinuation, all symptoms vanished and EEG normalized. We thus suggest that direct VPA-induced encephalopathy in the absence of ammonemia does exist, in this case probably facilitated by psychotropic polypharmacy.
近年来，丙戊酸（VPA）作为一种心境稳定剂的使用持续增加。虽然VPA通常耐受性良好，但将其与其他精神药物联合使用可能会增加不良反应的风险。在此，我们报告一例42岁男性难治性精神病性抑郁症患者，除锂盐、氯米帕明、氟哌噻吨和利培酮外，还给他开了VPA。这样做后，他出现了肌阵挛、震颤和脑病，并伴有镇静作用和脑电图背景明显减慢。最值得注意的是，这些副作用出现在VPA和血氨浓度正常的情况下。停用VPA后，所有症状消失，脑电图恢复正常。因此，我们认为在无氨血症的情况下确实存在直接由VPA引起的脑病，在本例中可能是由多种精神药物联合使用促成的。
