Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
Tremor Other Hyperkinet Mov (N Y). 2023 May 15;13:17. doi: 10.5334/tohm.755. eCollection 2023.
Valproic acid is associated with increased risks of tremor and parkinsonism.
A 67-year-old man with a diagnosis of epilepsy who had been treated with valproic acid (VPA) for 32 years noticed right-dominant upper-limb resting tremor accompanied by mild rigidity and bradykinesia. He was initially diagnosed with tremor-dominant Parkinson's disease (TDPD), but dopamine transporter single-photon emission computed tomography demonstrated no nigrostriatal degeneration. At 3 months after discontinuing VPA, his symptoms dramatically improved.
VPA-induced tremor usually consists of postural or kinetic tremor without asymmetry. Our case indicated that careful evaluation is needed, even in cases of asymmetrical resting tremor and mild parkinsonism resembling TDPD after long term exposure to VPA.
We report an atypical case of valproic acid-induced tremor and parkinsonism that mimics tremor-dominant Parkinson's disease. Physicians should not exclude the possible relation to valproic acid in patients presenting unilateral resting tremor and parkinsonism even in the absence of long-term side effects.
丙戊酸与震颤和帕金森病风险增加有关。
一位 67 岁的男性，患有癫痫，已接受丙戊酸（VPA）治疗 32 年，他注意到右侧优势上肢静止性震颤伴有轻度僵硬和运动迟缓。他最初被诊断为震颤为主的帕金森病（TDPD），但多巴胺转运体单光子发射计算机断层扫描未显示黑质纹状体变性。在停用 VPA 3 个月后，他的症状显著改善。
VPA 引起的震颤通常由姿势性或动力性震颤组成，无不对称性。我们的病例表明，即使在长期暴露于 VPA 后出现类似 TDPD 的不对称静止性震颤和轻度帕金森病，也需要进行仔细评估。
我们报告了一例不典型的丙戊酸诱导的震颤和帕金森病病例，其表现类似于震颤为主的帕金森病。即使在没有长期副作用的情况下，医生也不应该排除在出现单侧静止性震颤和帕金森病的患者中丙戊酸可能存在的关系。
