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Age and Ageing Advance Access originally published online on March 19, 2007
Age and Ageing 2007 36(3):344-346; doi:10.1093/ageing/afm019
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Case Reports

Is valproate encephalopathy under-recognised in older people? A case series

Stefan Beyenburg1,*, Claude Back1, Nico Diederich1, Mark Lewis2 and Markus Reuber3

1 Department of Neurology, Centre Hospitalier de Luxembourg, Rue Barblé 4, L-1210 Luxembourg, Luxembourg
2 Department of Neurology, Pinderfields General Hospital, Aberfield Road, Wakefield WF4 1DG, UK
3 Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield SF10 2JP, UK

Address correspondence to: S. Beyenburg. Email: beyenburg.stefan{at}chl.lu

Abstract

Background: valproate (VPA) is an antiepileptic drug with a broad spectrum of efficacy. Although usually well-tolerated, it may have side-effects of which encephalopathy is one of the most serious.

Objective: to describe the clinical characteristics of valproate encephalopathy (VE) in five older patients with remote symptomatic seizures treated with rapid VPA loading.

Design: case series.

Setting: teaching hospital

Patients: five patients (71–89 years old) with underlying cerebrovascular diseas or dementi and symptomatic seizures.

Results: VE was characterised by decline in conscious level and (in some cases) increase in seizure frequency. Three of the five patients had elevated ammonia levels. EEG showed generalised slow activity, in some cases accompanied by additional epileptic discharges. The condition was reversible in four patients after VPA discontinuation. One patient died.

Conclusions: older people may be at particular risk of VE because of co-morbid pathology, age-related metabolic changes and co-medication.

Keywords: valproic acid, valproate, epilepsy, encephalopathy, older people, elderly

Received 14 August 2006; accepted in revised form 25 January 2007.


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