Alsallumi Mohammed S
Department of Pediatrics, College of Medicine, Qassim University. E-mail:
Neurosciences (Riyadh). 2019 Oct;24(4):311-314. doi: 10.17712/nsj.2019.4.20190026.
Several studies have reported a variable benefit of valproic acid for the treatment of infantile spasm. However, valproic acid can also worsen spasms, as occurred with this child who presented with post-traumatic seizure which evolved to spasms. The child was started on antiepileptic medications, including valproic acid, despite that spasms persisting. For this reason, she was admitted for adrenocorticotropic hormone therapy. The baseline electroencephalogram showed modified hypsarrhythmia, and the laboratory workup showed thrombocytopenia, which was attributed to the valproic acid. After the valproic acid cessation, the spasms and the hypsarrhythmic pattern resolved dramatically next day, and the intended adrenocorticotropic hormone therapy was not started. Eight months later, she was still free of spasms. In conclusion, though valproic acid might have a beneficial effect in some patients with infantile spasm, it might have a negative impact on spasms in some patients which warrants its discontinuation sooner than later during spasms treatment.
多项研究报告了丙戊酸治疗婴儿痉挛症的疗效不一。然而，丙戊酸也可能使痉挛加重，就像这个患有创伤后癫痫并发展为痉挛的患儿一样。尽管痉挛持续存在，但该患儿还是开始使用包括丙戊酸在内的抗癫痫药物治疗。因此，她被收治以接受促肾上腺皮质激素治疗。基线脑电图显示改良型高峰失律，实验室检查显示血小板减少，这归因于丙戊酸。停用丙戊酸后，痉挛和高峰失律模式在第二天显著缓解，且未开始预期的促肾上腺皮质激素治疗。八个月后，她仍未出现痉挛。总之，虽然丙戊酸可能对一些婴儿痉挛症患者有有益作用，但它可能对一些患者的痉挛产生负面影响，这就需要在痉挛治疗期间尽早停用。
