Chicharro Ada V, de Marinis Alejandro J, Kanner Andres M
Departamento de Neurología Hospital Sótero del Río, Santiago, Chile.
Epilepsy Behav. 2007 Nov;11(3):361-6. doi: 10.1016/j.yebeh.2007.06.015. Epub 2007 Sep 12.
Hyperammonemia (HA) commonly occurs with the use of valproic acid (VPA); while it has no clinical significance in most cases, the Physician Desk Reference recommends its discontinuation in the presence of HA. The purpose of this study is to review the literature in order to estimate the prevalence and magnitude of HA in VPA treated patients, to establish any association with hepatotoxicity and encephalopathy and to identify any factors associated with its occurrence. A search of MEDLINE and Cochrane Database of Systematic Reviews, between 1980 and 2005 was performed. Out of 183 studies, 24 met our inclusion criteria. The prevalence of HA in the prospective studies ranged between 70% and 100%, while in cross-sectional studies it varied between 16% and 100%. Ammonia (NH(3)) blood levels increased by a two-fold average relative to the baseline levels. There was no association between HA and clinical symptoms. Concomitant administration of other antiepileptic drugs (AEDs) was the factor most frequently associated with HA.
高氨血症（HA）常与丙戊酸（VPA）的使用相关；虽然在大多数情况下它并无临床意义，但《医师案头参考》建议在出现HA时停用VPA。本研究的目的是回顾文献，以估计接受VPA治疗患者中HA的患病率和严重程度，确定其与肝毒性和脑病的任何关联，并识别与其发生相关的任何因素。检索了1980年至2005年间的MEDLINE和Cochrane系统评价数据库。在183项研究中，24项符合我们的纳入标准。前瞻性研究中HA的患病率在70%至100%之间，而横断面研究中则在16%至100%之间。氨（NH₃）血水平相对于基线水平平均升高了两倍。HA与临床症状之间无关联。同时使用其他抗癫痫药物（AEDs）是与HA最常相关的因素。
