Valproic Acid Complications [Neurosurgery Wiki]

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====== Valproic Acid Complications ======

Use of [[valproic acid]] during [[pregnancy]] is associated with a 1–2% risk of [[neural tube defect]] (NTD)
((Oakeshott P, Hunt GM. [[Valproate]] and [[Spina Bifida]]. Br Med J. 1989; 298:1300–1301)).

Valproic acid (VPA) is a commonly used drug for epilepsy, psychiatric disorders and migraine and is frequently used in neurosurgical intensive care units. Though most of its side-effects are mild and transient, certain idiosyncratic side-effects have been attributed to VPA. Valproate induced hyperammonemia (VIH) is one such side-effect
((Kumar A, Suri A, Sharma BS. Severe valproate induced hyperammonemic
encephalopathy successfully managed with peritoneal dialysis. Indian J Crit Care 
Med. 2014 Jul;18(7):461-3. doi: 10.4103/0972-5229.136076. PubMed PMID: 25097360; 
PubMed Central PMCID: PMC4118513.))

Valproate encephalopathy
((Zhu D, Su Z, Ye S, Chen X, Zhuge G, Wu Z. [Clinical misdiagnosis analysis of
valproate encephalopathy]. Zhonghua Yi Xue Za Zhi. 2014 Sep 9;94(33):2610-2.
Chinese. PubMed PMID: 25511495.
)).

Interstitial pneumonitis
((Kim SJ, Jhun BW, Lee JE, Kim K, Choi HY. A case of drug-induced interstitial
pneumonitis caused by valproic Acid for the treatment of seizure disorders.
Tuberc Respir Dis (Seoul). 2014 Sep;77(3):145-8. doi: 10.4046/trd.2014.77.3.145. 
Epub 2014 Sep 30. PubMed PMID: 25309611; PubMed Central PMCID: PMC4192314.)).
----
A considerable number of patients using VPA were diagnosed with [[coagulopathy]], especially [[platelet function disorder]]. Further [[prospective]] studies are needed to confirm the need for comprehensive [[laboratory]] testing before elective high-risk surgery in these patients
((Post DS, van der Veer A, Schijns OEMG, Klinkenberg S, Rijkers K, Wagner GL, van Kranen-Mastenbroek VHJM, Willems PCPH, Verhezen PWM, Beckers EAM, Heubel-Moenen FCJI, Henskens YMC. Assessment of need for hemostatic evaluation in patients taking valproic acid: A retrospective cross-sectional study. PLoS One. 2022 Feb 25;17(2):e0264351. doi: 10.1371/journal.pone.0264351. PMID: 35213601.)).