Valproate‐induced Parkinsonism in epilepsy patients

Abstract

We systematically examined 226 epilepsy patients in a tertiary-referral center and found 6 (5.04%) to have valproate-induced Parkinsonism. There was a significantly higher prevalence of patients with Parkinsonism in the group of patients treated with valproate compared to those who were on other antiepileptic drugs (6 [5.04%] of 119 vs. 0 [0%] of 107; chi2 = 5.54; P = 0.025). These six patients had been on valproate for more than 3 years (mean, 75.67 +/- 25.32 months) at an average dose of 750 +/- 273.86 mg/day. The valproate doses were decreased or discontinued with supplementation from another antiepileptic medication. The mean UPDRS motor score significantly improved from 10.67 +/- 5.1 to 4.75 +/- 2.75 (P < 0.05). There was no relapse of seizures. Clinicians working in tertiary-referral centers should have a high index of suspicion for valproate-induced Parkinsonism. Early recognition and switching into another antiepileptic medication may help reduce unnecessary suffering in these patients.

Does Chronic Administration of Sodium Valproate to Juvenile Rats Induce Movement Disorder and Cognitive Dysfunction during Adulthood?

“…Although the mechanism of SV-induced parkinsonism is not known, several biological theories have been proposed to explain this increased risk, including an effect on complex I activity in the electron transport chain of mitochondria [25] and on GABAergic pathways in the basal ganglia [32]. Apart from that, both oxidative stress and mitochondrial dysfunction have are also been attributed [27]. Functional neuroimaging in a few cases has shown that the striatonigral function appeared to be minimally affected.…”

Pharmacogenetics of parkinsonism, rigidity, rest tremor, and bradykinesia in African‐Caribbean inpatients: Differences in association with dopamine and serotonin receptors

“…Since the phenomenology of Morbus Parkinson is not essentially different from the phenomenology of drug-induced parkinsonism, we assume that the UPDRS is able to measure AIP. In fact, several studies have utilized the UPDRS for the measurement of drug-induced parkinsonism [van Harten et al, 1996Lera and Zirulnik, 1999;Hassin-Baer et al, 2001;Jamora et al, 2007]. Additionally, the UPDRS is far more comprehensive and balanced than the often used Simpson-Angus Scale (SAS), which has been criticized for overemphasizing rigidity items (6 out 10 items measure rigidity, while only 1 item measures tremor) as well as other shortcomings recently highlighted by Loonen and van Praag [2007].…”

Ters ilaç reaksiyonu olarak ilaçlarla indüklenen parkinsonizm

“…İlacı kullanan dört çocu-ğun ikisinde ilk 3 ayda ve diğer ikisinde de 2 yıl kronik kullanım sonucu serebellum atrofisi (psödoatrofi), tremor, ataksi ve minör EEG anomalileri görülmüştür (59). Özellikle ileri yaşta-ki hastalarda sodyum valproat kullanımı ile Parkinson hastalı-ğına benzer belirtiler görülmektedir (60,61). 36 hasta üzerinde yapılan bir prospektif çalışmada, 12 aydan uzun süreli sodyum valproat kullanımının geri-dönüşlü parkinsonizm ve kognitif zayıflamaya neden olduğu bildirilmiştir (62).…”