丙戊酸钠脑病2例报告
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摘要
丙戊酸钠脑病(VHE)为丙戊酸(VPA)严重但极为罕见的不良反应,多发生于服用VPA数天至数周后,临床主要表现为急性发作的意识障碍,大多数患者血氨升高,但肝功能正常,主要的治疗方式为停用VPA。现报道2例武汉市第一医院服用VPA数天及1 a后出现VHE的病例,均以间断发作性意识障碍及行为异常为临床表现,以提高对该病的认识。
Valproate-induced hyperammonemic encephalopathy(VHE) is a rare central nervous system adverse effect of valproate that is characterized by acute impaired consciousness,which usually occurs days to weeks after taking VPA.Most patients have elevated serum ammonia but normal liver function.The discontinuation of VPA is currently the mainstay of treatment for VHE.In this manuscript,we report 2 cases of VHE in our hospital after several days of taking VPA and one year later,both of which are characterized by intermittent paroxysmal disturbance of consciousness and behavior,so as to improve the understanding of the disease.
Valproate-induced hyperammonemic encephalopathy(VHE) is a rare central nervous system adverse effect of valproate that is characterized by acute impaired consciousness,which usually occurs days to weeks after taking VPA.Most patients have elevated serum ammonia but normal liver function.The discontinuation of VPA is currently the mainstay of treatment for VHE.In this manuscript,we report 2 cases of VHE in our hospital after several days of taking VPA and one year later,both of which are characterized by intermittent paroxysmal disturbance of consciousness and behavior,so as to improve the understanding of the disease.
引文
[1] CHENG M,TANG X,WEN S,et al.Valproate (VPA)-associated hyperammonemic encephalopathy independe-nt of elevated serum VPA levels:21 cases in China from May 2000 to May 2012[J].Compr Psychiatry,2013,54(5):562-567.
[2] GUO X,WEI J,GAO L,et al.Hyperammonemic coma after craniotomy:Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?:Case report and literature review[J].Medicine,2017,96(15):e6588.
[3] MURPHY J V,MARQUARDT K.Asymptomatic hyperammonemia in patients receiving valproic acid[J].Arch Neurol,1982,39(9):591-592.
[4] KIMMEL R J,IRWIN S A,MEYER J M.Valproic acid-associated hyperammonemic encephalopathy:a case report from the psychiatric setting[J].Int Clin Psychopharmacol,2005,20(1):57-58.
[5] GOMCELI Y B,KUTLU G,CAVDAR L,et al.Differe-nt clinical manifestations of hyperammonemic encephalopathy[J].Epilepsy Behav,2007,10(4):583-587.
[6] STEWART J T.A case of hyperammonemic encephalopathy after 11 years of valproate theraphy[J].J Clin Psychopharmacol,2008,28(3):361-362.
[7] RARU Y,ZEID F.Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate,a case report and review of the literature[J].Respir Med Case Rep,2018,25:1-3.
[8] BLINDAUER K A,HARRINGTON G,MORRIS G L,et al.Fulminant progression of demyelinating disease after valproate-induced encephalopathy[J].Neurology,1998,51(1):292-295.
[9] DEUTSCH S I,BURKET J A,ROSSE R B.Valproate-induced hyperammonemic encephalopathy and normal liver functions:possible synergism with topiramate[J].Clinical Neuropharmacology,2009,32(6):350-352.
[10] VERMA R,KORI P.Valproate-induced encephalopa-thy with predominant pancerebellar syndrome[J].Indian J Pharmacol,2012,44(1):129-130.
[11] ABREU L N,ISSLER C,LAFER B.Valproate-induced reversible pseudoatrophy of the brain and hyperammonemic encephalopathy in a bipolar patient[J].Aust N Z J Psychiatry,2009,43(5):484-485.
[12] PéREZESPARZA R,O?ATECADENA N,RAMíR-EZBERMǘDEZ J,et al.Valproate-induced Hyperammonemic Encephalopathy Presenting as Catatonia[J].Neurologist,2018,23(2):51-52.
[13] GURJAR M,SINGHAL S,BARONIA A K,et al.Valproate-induced hyperammonemic encephalopathy:A reminder of rare complication of valproate.[J].J Emerg Trauma Shock,2011,4(2):321-322.
[14] DUARTE J,MACIAS S,CORIA F,et al.Valproate-induced coma:case report and literature review[J].Ann Pharmacother,1993,27(5):582-583.
[15] 王林.丙戊酸钠脑病1例[J].临床合理用药杂志,2015,8(9B):166-167.
[16] OTT C A,CAMPBELL N,DWOREK E A.Valproic Acid Induced Hyperammonemia in a Patient With Schizoaffective Disorder[J].J Pharmacy Practice,2007,20(20):82-92.
[17] B?HMER T,B?EN A,H?YMORK S C.Valproate-induced hyperammonemic encephalopathy,rapidly improved by i.v.carnitine and glucose/thiamine[J].Scand J Gastroenterol,2010,45(6):762-763.
[18] KUMAR A,SURI A,SHARMA B S.Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis[J].Indian J Crit Care Med,2014,18(7):461-463.
[19] TRIGGS W J,GILMORE R L,MILLINGTON D S,et al.Valproate-associat-ed carnitine deficiency and malignant cerebral edema in the ab-sence of hepatic failure[J].Int J Clin Pharmacol Ther,1997,35(9):353-356.
[2] GUO X,WEI J,GAO L,et al.Hyperammonemic coma after craniotomy:Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?:Case report and literature review[J].Medicine,2017,96(15):e6588.
[3] MURPHY J V,MARQUARDT K.Asymptomatic hyperammonemia in patients receiving valproic acid[J].Arch Neurol,1982,39(9):591-592.
[4] KIMMEL R J,IRWIN S A,MEYER J M.Valproic acid-associated hyperammonemic encephalopathy:a case report from the psychiatric setting[J].Int Clin Psychopharmacol,2005,20(1):57-58.
[5] GOMCELI Y B,KUTLU G,CAVDAR L,et al.Differe-nt clinical manifestations of hyperammonemic encephalopathy[J].Epilepsy Behav,2007,10(4):583-587.
[6] STEWART J T.A case of hyperammonemic encephalopathy after 11 years of valproate theraphy[J].J Clin Psychopharmacol,2008,28(3):361-362.
[7] RARU Y,ZEID F.Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate,a case report and review of the literature[J].Respir Med Case Rep,2018,25:1-3.
[8] BLINDAUER K A,HARRINGTON G,MORRIS G L,et al.Fulminant progression of demyelinating disease after valproate-induced encephalopathy[J].Neurology,1998,51(1):292-295.
[9] DEUTSCH S I,BURKET J A,ROSSE R B.Valproate-induced hyperammonemic encephalopathy and normal liver functions:possible synergism with topiramate[J].Clinical Neuropharmacology,2009,32(6):350-352.
[10] VERMA R,KORI P.Valproate-induced encephalopa-thy with predominant pancerebellar syndrome[J].Indian J Pharmacol,2012,44(1):129-130.
[11] ABREU L N,ISSLER C,LAFER B.Valproate-induced reversible pseudoatrophy of the brain and hyperammonemic encephalopathy in a bipolar patient[J].Aust N Z J Psychiatry,2009,43(5):484-485.
[12] PéREZESPARZA R,O?ATECADENA N,RAMíR-EZBERMǘDEZ J,et al.Valproate-induced Hyperammonemic Encephalopathy Presenting as Catatonia[J].Neurologist,2018,23(2):51-52.
[13] GURJAR M,SINGHAL S,BARONIA A K,et al.Valproate-induced hyperammonemic encephalopathy:A reminder of rare complication of valproate.[J].J Emerg Trauma Shock,2011,4(2):321-322.
[14] DUARTE J,MACIAS S,CORIA F,et al.Valproate-induced coma:case report and literature review[J].Ann Pharmacother,1993,27(5):582-583.
[15] 王林.丙戊酸钠脑病1例[J].临床合理用药杂志,2015,8(9B):166-167.
[16] OTT C A,CAMPBELL N,DWOREK E A.Valproic Acid Induced Hyperammonemia in a Patient With Schizoaffective Disorder[J].J Pharmacy Practice,2007,20(20):82-92.
[17] B?HMER T,B?EN A,H?YMORK S C.Valproate-induced hyperammonemic encephalopathy,rapidly improved by i.v.carnitine and glucose/thiamine[J].Scand J Gastroenterol,2010,45(6):762-763.
[18] KUMAR A,SURI A,SHARMA B S.Severe valproate induced hyperammonemic encephalopathy successfully managed with peritoneal dialysis[J].Indian J Crit Care Med,2014,18(7):461-463.
[19] TRIGGS W J,GILMORE R L,MILLINGTON D S,et al.Valproate-associat-ed carnitine deficiency and malignant cerebral edema in the ab-sence of hepatic failure[J].Int J Clin Pharmacol Ther,1997,35(9):353-356.