Ordoño-Saiz MV, Púa-Torrejón RC, Justel-Rodríguez M, Arias-Vivas E, Heppe-Montero M, González-Alguacil E, Duat-Rodríguez A, Ruiz-Falcó-Rojas ML, García-Peñas JJ, Gutiérrez-Delicado E, Soto-Insuga V. Cerebral and cerebellar pseudoatrophy associated with valproic acid. Report of three pediatric cases.
Rev Neurol 2023;
77:197-201. [PMID:
37807884 PMCID:
PMC10831757 DOI:
10.33588/rn.7708.2023186]
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Abstract
INTRODUCTION
Cerebral and cerebellar pseudoatrophy is a rare adverse effect of valproic acid (VPA) that we need to be aware of, due to its diagnostic and therapeutic implications.
CASE REPORT
We report three cases of children between 5 and 9 years old, with epilepsy and previous normal brain magnetic resonance imaging, who were taking the drug at correct doses. Pseudoatrophy manifests subacutely with symptoms and images of cerebral and/or cerebellar atrophy, reversible after drug withdrawal.
DISCUSSION AND CONCLUSIONS
This is a type of VPA-related encephalopathy, different from dose-dependent toxic encephalopathy, hyperammonaemic encephalopathy or encephalopathy related to liver failure. In children, it causes cognitive, motor, mood and behavioral deterioration, and may be accompanied by epileptic decompensation. Withdrawing the drug leads to complete clinical-radiological recovery, and reducing the dose leads to improvement.
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