Valproic acid
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Parkinsonism in an elderly patient?: case report A 67-year-old woman developed parkinsonism during treatment with valproic acid for a seizure disorder. The woman, who had been receiving valproic acid [Epilim Chrono] 300mg twice daily for > 10 years, diazepam and mirtazapine, was admitted with poor mobility and abdominal pain due to faecal impaction. Further investigation revealed a long history of upper limb tremor that was becoming progressively worse; she could not provide a precise time scale, but confirmed that the symptom had been present for some years. Examination revealed hypophonia and decreased facial expression. The presence of an asymmetrical, jerky, postural and resting upper limb tremor that was worse on her right side was noted. Coactivation techniques increased her underlying rigidity. General body, and moderate limb, bradykinesias were present and more marked on her right side than her left. Her function was poor and she required assistance from one person for mobilisation. It was suspected that she may have had essential tremor that later developed into parkinsonism. Analysis to exclude underlying parkinsonism provided a working diagnosis of Parkinson’s disease, but the contribution of valproic acid and a vascular cause could not be ruled out. The woman started receiving levodopa/benserazide [Cobeneldopa], while continuing to receive valproic acid, and her mobilisation became independent and she was discharged. Author comment: "While [valproic acid]-induced Parkinsonism may be a more probable diagnosis in a younger population, in older subjects, there is more likely to be an increasing incidence of underlying Parkinson’s disease and other presynaptic degenerations." MacPhee GJA, et al. Diagnosis of Parkinsonism in older patients receiving sodium valproate. Movement Disorders 22: 1211, No. 8, 15 Jun 2007 801071867 Scotland
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Reactions 14 Jul 2007 No. 1160
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