Reversible Pseudoatrophy of the Brain and Mental Deterioration Associated with Valproate Treatment

摘要: Summary: Purpose: To describe an 11-year-old girl with symptomatic localization-related epilepsy and normal intelligence who developed reversible mental deterioration pseudoatrophic brain changes while receiving valproate (VPA). Methods: Assessment of function using Wechsler Intelligence Scale for Children-III (WISC) Raven's Progressive Matrices (PM), EEG recordings awake asleep, magnetic resonance imaging (MRI), were performed at the beginning VPA therapy, after 2 years 8 months treatment following discontinuation. Results: After 6 on (≤26 mg/kg/day) insidiously (loss 18 IQ points drop in age-adjusted PM score from 95th to 50th percentile) associated MRI-documented pseudoatrophy brain. Onset severe cognitive impairment coincided serum concentrations near 100 μg/ml. There no other manifestations drug toxicity or hyperammonemia. Background activity was normal. Reduction dosage subsequent discontinuation 4 later resulted disappearance clinical symptoms a 20-point improvement testing recovery previous score. Repeat MRI showed changes. Conclusions: The striking reversal strongly suggest drug-induced condition. Based this reports, syndrome VPA-associated appears encompass different but possibly related entities, which include parkinsonism deterioration, signs VPA-toxicity, isolated as seen our patient. A effect should be considered whenever findings atrophy occur VPA-treated patients.