Rath Amitav, Naryanan T Jaishree, Chowdhary G V S, Murthy J M K
Department of Neurology, The Institute of Neurological Sciences, CARE Hospital, Hyderabad, India.
Neurol India. 2005 Jun;53(2):226-8. doi: 10.4103/0028-3886.16420.
Hyperammonemic encephalopathy with normal liver function is an uncommon serious adverse effect of valproate therapy. We retrospectively analyzed the case records of 5 patients of epilepsy on valproate with hyperammonemic encephalopathy. Of the 5 patients, 3 were on monotherapy. The mean valproate dose was 1250 mg/day and the duration of therapy ranged between 4 and 90 days. Alteration in the sensorium was the presenting clinical feature. The risk factors included high initial dose (2), long-term valproate therapy (1), and long-term valproate therapy with concomitant topiramate (1). There was good correlation between the fall in serum ammonia levels and clinical improvement. Hyperammonemic encephalopathy should be suspected in patients on valproate with altered sensorium. Response to treatment is rewarding.
肝功能正常的高氨血症性脑病是丙戊酸盐治疗罕见但严重的不良反应。我们回顾性分析了5例服用丙戊酸盐且患有高氨血症性脑病的癫痫患者的病历。这5例患者中，3例接受单药治疗。丙戊酸盐平均剂量为1250毫克/天，治疗时间为4至90天。意识改变是主要的临床特征。危险因素包括初始剂量高（2例）、长期丙戊酸盐治疗（1例）以及长期丙戊酸盐治疗联合托吡酯（1例）。血清氨水平下降与临床改善之间存在良好相关性。对于意识改变的丙戊酸盐治疗患者，应怀疑患有高氨血症性脑病。治疗反应良好。
