VALPROIC ACID INDUCED HYPERAMMONEMIC ENCEPHALOPATHY

Valproic acid (VPA) has been used in clinical practice since 60’s, with a relatively favourable safety and efficacy profile. Pancreatitis, hepatotoxicity and teratogenicity are the most significant adverse drug reactions. VPA-induced hyperammonemia include: lethargy, impaired consciousness, focal neurological signs and symptoms and increased seizure frequency. More rare described symptoms are: aggression, ataxia, asterixis, vomiting and coma. We report a patient with migraine who developed hyperammonemic encephalopathy in association with valproic acid. The condition improved with a strike of valproic acid and the treatment with carnitine at a dose of 50mg/kg/day for four days.