Wroblewski B A, Joseph A B, Kupfer J, Kalliel K
Greenery Rehabilitation Center, Boston, MA 02135, USA.
Brain Inj. 1997 Jan;11(1):37-47. doi: 10.1080/026990597123791.
Valproic acid, a primary anticonvulsant drug, has recently been studied for purported effectiveness in disparate disorders of mood and behaviour. The psychopharmacological treatment of patients with acquired brain injury frequently includes numerous trials of psychotherapeutic drugs such as antipsychotics, benzodiazepines, antidepressants, and lithium, in an effort towards affective and behavioural improvement. In this report we describe and graphically depict the striking efficacy of valproic acid in reducing and improving destructive and aggressive behaviours in five patients with acquired brain injury. In all cases valproic acid was effective after other pharmacological interventions were not. Also, the addition of valproic acid was followed by neurobehavioural improvement rather quickly, often within 1-2 weeks. Advantages of valproic acid, in addition to its possible unique efficacy, include a lower propensity towards sedation and cognitive impairment, and thus a more robust potential for rehabilitation participation. Behaviours associated with affective disorders ranging along the affective spectrum from depression to dysphoric mania may be particularly amenable to valproic acid. The drug may also be beneficial in some cases in which another psychotropic anticonvulsant, carbamazepine, was not.
丙戊酸是一种主要的抗惊厥药物，最近人们对其在不同情绪和行为障碍方面所谓的疗效进行了研究。对后天性脑损伤患者的心理药物治疗通常包括对多种心理治疗药物进行多次试验，如抗精神病药物、苯二氮䓬类药物、抗抑郁药物和锂盐，以努力改善情感和行为。在本报告中，我们描述并以图表形式展示了丙戊酸在减少和改善5例后天性脑损伤患者的破坏性行为和攻击性行为方面的显著疗效。在所有病例中，在其他药物干预无效后，丙戊酸均有效。此外，加用丙戊酸后神经行为改善相当迅速，通常在1 - 2周内。丙戊酸的优点，除了其可能具有独特的疗效外，还包括镇静和认知障碍倾向较低，因此参与康复的潜力更大。与情感障碍相关的行为，从抑郁到烦躁性躁狂，在情感谱系中范围较广，可能对丙戊酸特别敏感。在某些另一种精神性抗惊厥药物卡马西平无效的情况下，该药物可能也有益处。
