valproic acid and Hepatic Encephalopathy studies

Valproic Acid: A fatty acid with anticonvulsant and anti-manic properties that is used in the treatment of EPILEPSY and BIPOLAR DISORDER. The mechanisms of its therapeutic actions are not well understood. It may act by increasing GAMMA-AMINOBUTYRIC ACID levels in the brain or by altering the properties of VOLTAGE-GATED SODIUM CHANNELS.
valproic acid : A branched-chain saturated fatty acid that comprises of a propyl substituent on a pentanoic acid stem.

Hepatic Encephalopathy: A syndrome characterized by central nervous system dysfunction in association with LIVER FAILURE, including portal-systemic shunts. Clinical features include lethargy and CONFUSION (frequently progressing to COMA); ASTERIXIS; NYSTAGMUS, PATHOLOGIC; brisk oculovestibular reflexes; decorticate and decerebrate posturing; MUSCLE SPASTICITY; and bilateral extensor plantar reflexes (see REFLEX, BABINSKI). ELECTROENCEPHALOGRAPHY may demonstrate triphasic waves. (From Adams et al., Principles of Neurology, 6th ed, pp1117-20; Plum & Posner, Diagnosis of Stupor and Coma, 3rd ed, p222-5)

Research Excerpts

Excerpt	Relevance	Reference
"Our purpose was to evaluate the relationship between valproic acid (VPA)-induced hyperammonemia (HA) and the prevalence of minimal hepatic encephalopathy (MHE) cognitive impairment among psychiatric inpatients."	7.83	Valproic acid-induced hyperammonemia and minimal hepatic encephalopathy prevalence among psychiatric inpatients. ( Doroudgar, S; La, AQ; Perry, PJ; Punia, S; Thomas, KL, 2016)
"Our purpose was to evaluate the relationship between valproic acid (VPA)-induced hyperammonemia (HA) and the prevalence of minimal hepatic encephalopathy (MHE) cognitive impairment among psychiatric inpatients."	3.83	Valproic acid-induced hyperammonemia and minimal hepatic encephalopathy prevalence among psychiatric inpatients. ( Doroudgar, S; La, AQ; Perry, PJ; Punia, S; Thomas, KL, 2016)
"The authors report a case of fatal hepatic failure in a 19-year old young man suffering from absence seizures and treated for two months with valproic acid (VPA)."	3.69	[Fatal hepatic necrosis during treatment with sodium valproate]. ( Benaguida, M; Chlihi, A; Miguil, M; Mjahed, K; Moutawakkil, S; Sarf, I, 1995)
" Hyperammonemic coma is determined through a complicated differential diagnosis, and although it can also be induced as a side effect of valproate (VPA), this cause is frequently unrecognized or confused with upper gastrointestinal hemorrhage (UGH)-induced hepatic encephalopathy."	2.55	Hyperammonemic coma after craniotomy: Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?: Case report and literature review. ( Gao, L; Guo, X; Wei, J; Xing, B; Xu, Z, 2017)
"We report a 66-year-old man with hepatic encephalopathy due to a non-cirrhotic porto-systemic shunt during the course of treatment for epilepsy with sodium valproate."	2.43	[Successful balloon-occluded retrograde transvenous obliteration (B-RTO) in a case of symptomatic epilepsy with hepatic encephalopathy due to non-cirrhotic porto-systemic shunt]. ( Hayashi, S; Noguchi, M; Shibata, A, 2005)
"Valproic acid (VPA) is a broad-spectrum antiepileptic drug and is usually well tolerated, but rare serious complications may occur in some patients receiving VPA chronically, including haemorrhagic pancreatitis, bone marrow suppression, VPA-induced hepatotoxicity (VHT) and VPA-induced hyperammonaemic encephalopathy (VHE)."	2.43	Science review: carnitine in the treatment of valproic acid-induced toxicity - what is the evidence? ( Gris, M; Lheureux, PE; Penaloza, A; Zahir, S, 2005)
"Carnitine is an important nutrient that is present in the diet (particularly in meat and dairy products) and is synthesized from dietary amino acids."	2.38	Carnitine, valproate, and toxicity. ( Coulter, DL, 1991)
" At the time of deterioration, serum valproate was at toxic level in the three reported cases."	1.32	Delayed toxicity following acute ingestion of valpromide. ( Descotes, J; Frantz, P; Martin, O; Moulsma, M; Parant, F; Payen, C; Pulce, C, 2004)
"A 29-year-old female patient with Friedreich's ataxia and partial seizures with acute liver failure during VPA treatment is reported."	1.30	Fatal liver failure associated with valproate therapy in a patient with Friedreich's disease: review of valproate hepatotoxicity in adults. ( Hehlmann, R; Heubner, C; Holm, E; König, I; König, SA; Schenk, M; Sick, C; Weiss, A, 1999)
"We report a 3 year-old girl with a myoclonic epilepsy."	1.29	Valproate-induced hepatic failure in a case of cytochrome c oxidase deficiency. ( Chabrol, B; Chretien, D; Mancini, J; Munnich, A; Pinsard, N; Rustin, P, 1994)
"Here a case of hemorrhagic shock and fulminant hepatic failure in a patient treated with valproate is presented."	1.29	[Hemorrhagic shock and fulminant hepatic failure associated with valproate]. ( Fernandez-Fernandez, FJ; Garcia-Jimenez, A; Garcia-Rego, J; Sesma, P, 1995)

Research

Studies (34)

Authors

Clinical Trials (3)

Trial Overview

Trial Outcomes

Anthropometric Measures of Nutritional Status (Body Mass Index [BMI] Z-scores, Weight for Length Ratios, Lean/Fat Mass Via DEXA, Growth Parameters, and Triceps Skinfold Measures)

Max CMAP Amplitude (Mean)

Timeframe	Studies, this research(%)	All Research%
pre-1990	5 (14.71)	18.7374
1990's	14 (41.18)	18.2507
2000's	9 (26.47)	29.6817
2010's	6 (17.65)	24.3611
2020's	0 (0.00)	2.80

Authors	Studies
Guo, X	1
Wei, J	1
Gao, L	1
Xing, B	1
Xu, Z	1
Amathieu, R	1
Levesque, E	1
Merle, JC	1
Chemit, M	1
Costentin, C	1
Compagnon, P	1
Dhonneur, G	1
Thomas, KL	1
La, AQ	1
Punia, S	1
Doroudgar, S	1
Perry, PJ	1
Rousseau, MC	1
Montana, M	1
Villano, P	1
Catala, A	1
Blaya, J	1
Valkov, M	1
Allouard, Y	1
Bugni, E	1
Dichtwald, S	1
Dahan, E	1
Adi, N	1
Moses, A	1
Sorkine, P	1
Rupasinghe, J	1
Jasinarachchi, M	1
Lewis, C	1
Deshpande, A	1
Tesar, GE	1
Dale, R	1
Payen, C	1
Frantz, P	1
Martin, O	1
Parant, F	1
Moulsma, M	1
Pulce, C	1
Descotes, J	1
McCall, M	1
Bourgeois, JA	1
Shibata, A	1
Hayashi, S	1
Noguchi, M	1
Rossetti, AO	1
Bromfield, EB	1
Lheureux, PE	1
Penaloza, A	1
Zahir, S	1
Gris, M	1
Segura-Bruna, N	1
Rodriguez-Campello, A	1
Puente, V	1
Roquer, J	1
Velioğlu, SK	1
Gazioğlu, S	1
Subhash, HS	1
Heddle, RJ	1
Schultz, DW	1
Ring, J	1
Thompson, CH	1
Le Bihan, G	1
Bourreille, J	1
Sampson, M	1
Leroy, J	1
Szekely, AM	1
Coquerel, A	1
Addison, GM	1
Gordon, NS	1
Imler, M	1
Warter, JM	1
Marescaux, C	1
Miguil, M	1
Chlihi, A	1
Mjahed, K	1
Sarf, I	1
Moutawakkil, S	1
Benaguida, M	1
Puri, AS	1
Sharma, BC	1
Khan, EM	1
Saraswat, VA	1
Treem, WR	1
Chabrol, B	1
Mancini, J	1
Chretien, D	1
Rustin, P	1
Munnich, A	1
Pinsard, N	1
Fernandez-Fernandez, FJ	1
Garcia-Rego, J	1
Garcia-Jimenez, A	1
Sesma, P	1
Beversdorf, D	1
Allen, C	1
Nordgren, R	1
König, SA	1
Schenk, M	1
Sick, C	1
Holm, E	1
Heubner, C	1
Weiss, A	1
König, I	1
Hehlmann, R	1
Wirshing, WC	1
Ames, D	1
Bisheff, S	1
Pierre, JM	1
Mendoza, A	1
Sun, A	1
Brätter, P	1
Brunetto, R	1
Gramm, HJ	2
Recknagel, S	1
Siemes, H	2
Nau, H	1
Seidel, U	1
Bell, EA	1
Shaefer, MS	1
Markin, RS	1
Wood, RP	1
Langnas, AN	1
Stratta, RJ	1
Shaw, BW	1
Willmore, LJ	1
Triggs, WJ	1
Pellock, JM	1
Coulter, DL	1
Binek, J	1
Hany, A	1
Egloff, B	1
Heer, M	1
van Egmond, H	1
Degomme, P	1
de Simpel, H	1
Dierick, AM	1
Roels, H	1
König, S	1
Scheffner, D	1
Rauterberg-Ruland, I	1
Kochen, W	1
Hofmann, WJ	1
Wokittel, E	1
Schick, U	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
In Vivo Study of Safety, Tolerability and Dosing Effect on SMN mRNA and Protein Levels of Valproic Acid in Patients With Spinal Muscular Atrophy[NCT00374075]	Phase 1	42 participants	Interventional	2003-09-30	Completed
Phase I/II Trial of Valproic Acid and Carnitine in Infants With Spinal Muscular Atrophy Type I (CARNI-VAL Type I)[NCT00661453]	Phase 1/Phase 2	40 participants (Actual)	Interventional	2008-04-30	Completed
Multi-center Phase II Trial of Valproic Acid and Carnitine in Patients With Spinal Muscular Atrophy (SMA CARNI-VAL Trial)[NCT00227266]	Phase 2	94 participants (Actual)	Interventional	2005-09-30	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Intervention	g (Mean)
	Lean Mass Baseline	Lean Mass 3 months	Lean Mass 6 months	Fat Mass Baseline	Fat Mass 3 months	Fat Mass 6 months
SMA Type 1	4317.15	4993.92	5133.83	3011.37	3618.25	4316.08

The maximum Compound Motor Action Potential (CMAP) is a measurement obtained through EMG testing that is associated with disease progression. In this study, we measure the maximum CMAP by stimulating one nerve in the hand and measuring the response of the muscle. This is done multiple times, the outcome used is the highest peak, or response observed. (NCT00227266)
Timeframe: 1 month prior to official enrollment, beginning of study (0 months), 6 months, 12 months (data point not available)

Max CMAP Amplitude Median

Intervention	mV (Mean)
	Baseline	6 months
Cohort 1a Sitters Placebo Then Treatment	2.28	2.32
Cohort 1b Sitters Treatment	2.93	2.37
Cohort 2 Standers and Walkers - Treatment	5.52	6.56

Max CMAP Area (Mean)

Intervention	mV (Median)
	Baseline	6 months
Cohort 1a Sitters Placebo Then Treatment	1.91	1.44
Cohort 1b Sitters Treatment	2.2	1.8
Cohort 2 Standers and Walkers - Treatment	5.3	5.85

The maximum Compound Motor Action Potential (CMAP) area is a measurement obtained through EMG testing that is associated with disease progression. In this study, we measure the maximum CMAP by stimulating one nerve in the hand and measuring the response of the muscle. This procedure is repeated multiple times. The maximum area is the response that results in the largest area under the response curve. (NCT00227266)
Timeframe: 1 month prior to official enrollment, beginning of study (0 months), 6 months, 12 months (data point not available)

Max CMAP Area (Median)

Intervention	mVms (Mean)
	Baseline	6 months
Cohort 1a Sitters Placebo Then Treatment	5.46	5.28
Cohort 1b Sitters Treatment	5.45	5.26
Cohort 2 Standers and Walkers - Treatment	14.85	16.26

Modified Hammersmith Change From Baseline to 6 Months

Intervention	mVms (Median)
	Baseline	6 months
Cohort 1a Sitters Placebo Then Treatment	3.6	3.74
Cohort 1b Sitters Treatment	4.6	3.4
Cohort 2 Standers and Walkers - Treatment	13.65	16.85

Comparison of Modified Hammersmith Change from baseline to 6 months. Scores range from 0 to 40. A higher score indicates a better outcome. This scale is used to assess gross motor abilities of non-ambulant children with SMA in multiple research trials as well as in clinical settings. (NCT00227266)
Timeframe: 0 months, 6 months

Modified Hammersmith Extend Baseline

Intervention	Score (Mean)
	Baseline visit (0 weeks)	6 Month visit (V2)	Change from Baseline
Cohort 1a Sitters Placebo Then Treatment	20.0	20.6	0.6
Cohort 1b Sitters Treatment	16.6	16.8	0.2

"Baseline Modified Hammersmith Extend testing. The baseline test is the score they receive during their screening visits. This scale ranges from 0 to 56. A higher score indicates a better outcome.~This scale is used to assess gross motor abilities of children with SMA in multiple research trials as well as in clinical settings." (NCT00227266)
Timeframe: 1 month prior to enrollment, at enrollment (0 months)

Intervention	Score (Mean)
	Modified Hammersmith Extend at S1 (-4 weeks)	Modified Hammersmith Extend at S2 (0 weeks)
Cohort 2 Experimental	47.0	48.3

Article	Year
Hyperammonemic coma after craniotomy: Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?: Case report and literature review. Medicine, 2017, Volume: 96, Issue:15 Topics: Anticonvulsants; Coma; Craniotomy; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Hep	2017
[Severe toxic acute liver failure: etiology and treatment]. Annales francaises d'anesthesie et de reanimation, 2013, Volume: 32, Issue:6 Topics: Acetaminophen; Acetylcysteine; Acute Kidney Injury; Anti-Infective Agents; Blood Coagulation Disorde	2013
Valproate-induced hyperammonemic encephalopathy: a brief review. Current medical research and opinion, 2012, Volume: 28, Issue:6 Topics: Adult; Anticonvulsants; Child; Hepatic Encephalopathy; Humans; Hyperammonemia; Models, Biological; N	2012
[Successful balloon-occluded retrograde transvenous obliteration (B-RTO) in a case of symptomatic epilepsy with hepatic encephalopathy due to non-cirrhotic porto-systemic shunt]. Rinsho shinkeigaku = Clinical neurology, 2005, Volume: 45, Issue:5 Topics: Aged; Anticonvulsants; Balloon Occlusion; Epilepsy; Hepatic Encephalopathy; Humans; Hyperammonemia;	2005
Science review: carnitine in the treatment of valproic acid-induced toxicity - what is the evidence? Critical care (London, England), 2005, Oct-05, Volume: 9, Issue:5 Topics: Anticonvulsants; Carnitine; Chemical and Drug Induced Liver Injury; Drug Overdose; Hepatic Encephalo	2005
Valproate-induced hyperammonemic encephalopathy. Acta neurologica Scandinavica, 2006, Volume: 114, Issue:1 Topics: Anticonvulsants; Brain; Brain Edema; Carbamoyl-Phosphate Synthase (Glutamine-Hydrolyzing); Carnitine	2006
Inherited and acquired syndromes of hyperammonemia and encephalopathy in children. Seminars in liver disease, 1994, Volume: 14, Issue:3 Topics: Ammonia; Child; Hepatic Encephalopathy; Humans; Liver Diseases; Metabolism, Inborn Errors; Reye Synd	1994
Valproate toxicity: risk-screening strategies. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Enzymes; Epilepsy; Hepatic Encephalopathy;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
Carnitine, valproate, and toxicity. Journal of child neurology, 1991, Volume: 6, Issue:1 Topics: Carnitine; Chemical and Drug Induced Liver Injury; Child; Epilepsy; Hepatic Encephalopathy; Humans;	1991
[Acute fatal liver insufficiency due to valproic acid therapy]. Schweizerische medizinische Wochenschrift, 1991, Feb-16, Volume: 121, Issue:7 Topics: Adult; Chemical and Drug Induced Liver Injury; Epilepsy; Hepatic Encephalopathy; Humans; Liver; Male	1991

Article	Year
Valproic acid-induced hyperammonemia and minimal hepatic encephalopathy prevalence among psychiatric inpatients. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2016, Volume: 28, Issue:1 Topics: Adult; Antimanic Agents; Cognitive Dysfunction; Female; Hepatic Encephalopathy; Humans; Hyperammonem	2016
Valproic acid-induced encephalopathy in very long course treated patients. Brain injury, 2009, Volume: 23, Issue:12 Topics: Adolescent; Adult; Anticonvulsants; Brain Damage, Chronic; Dose-Response Relationship, Drug; Female;	2009
Molecular adsorbent recycling system therapy in the treatment of acute valproic acid intoxication. The Israel Medical Association journal : IMAJ, 2010, Volume: 12, Issue:5 Topics: Acute Disease; Adult; Antimanic Agents; Charcoal; Drug Overdose; Fluid Therapy; Hemoperfusion; Hepat	2010
Progressive encephalopathy with cerebral oedema and infarctions associated with valproate and diazepam overdose. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2011, Volume: 18, Issue:5 Topics: Adult; Antimanic Agents; Brain Edema; Brain Infarction; Chemical and Drug Induced Liver Injury; Coma	2011
Delayed toxicity following acute ingestion of valpromide. Human & experimental toxicology, 2004, Volume: 23, Issue:3 Topics: Adult; Anticonvulsants; Coma; Dyspnea; Female; Hepatic Encephalopathy; Humans; Male; Prodrugs; Time	2004
Valproic acid-induced hyperammonemia: a case report. Journal of clinical psychopharmacology, 2004, Volume: 24, Issue:5 Topics: Ammonia; Anticonvulsants; Blood Urea Nitrogen; Consciousness Disorders; Diagnosis, Differential; Dru	2004
Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology, 2005, Aug-09, Volume: 65, Issue:3 Topics: Anticonvulsants; Brain; Dose-Response Relationship, Drug; Drug Administration Schedule; Electroencep	2005
Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy. Acta neurologica Scandinavica, 2007, Volume: 116, Issue:2 Topics: Adult; Ammonia; Anticonvulsants; Brain; Electroencephalography; Hepatic Encephalopathy; Humans; Hype	2007
Hepatic encephalopathy precipitated by sodium valproate therapy. The Medical journal of Australia, 2008, May-05, Volume: 188, Issue:9 Topics: Aged; Anticonvulsants; Biopsy; Diagnosis, Differential; Electroencephalography; Female; Follow-Up St	2008
Fatal hepatic failure and sodium valproate. Lancet (London, England), 1980, Dec-13, Volume: 2, Issue:8207 Topics: Adolescent; Cholestasis; Epilepsy, Absence; Female; Hepatic Encephalopathy; Humans; Valproic Acid	1980
Sodium valproate and acute hepatic failure. Developmental medicine and child neurology, 1980, Volume: 22, Issue:2 Topics: Acute Disease; Female; Hepatic Encephalopathy; Humans; Infant; Valproic Acid	1980
[Sodium valproate, hyperammonemia and hepatic encephalopathy]. Gastroenterologie clinique et biologique, 1982, Volume: 6, Issue:12 Topics: Ammonia; Hepatic Encephalopathy; Humans; Valproic Acid	1982
[Fatal hepatic necrosis during treatment with sodium valproate]. Cahiers d'anesthesiologie, 1995, Volume: 43, Issue:3 Topics: Adult; Anticonvulsants; Chemical and Drug Induced Liver Injury; Fatal Outcome; Hepatic Encephalopath	1995
Fatal fulminant hepatic failure due to sodium valproate in an adolescent. Indian pediatrics, 1994, Volume: 31, Issue:2 Topics: Adolescent; Brain Diseases; Drug Therapy, Combination; Fatal Outcome; Hepatic Encephalopathy; Humans	1994
Valproate-induced hepatic failure in a case of cytochrome c oxidase deficiency. European journal of pediatrics, 1994, Volume: 153, Issue:2 Topics: Amino Acids; Child, Preschool; Chromatography, Gas; Cytochrome-c Oxidase Deficiency; Epilepsies, Myo	1994
[Hemorrhagic shock and fulminant hepatic failure associated with valproate]. Anales de medicina interna (Madrid, Spain : 1984), 1995, Volume: 12, Issue:12 Topics: Anticonvulsants; Child; Hepatic Encephalopathy; Humans; Liver; Male; Shock, Hemorrhagic; Status Epil	1995
Valproate induced encephalopathy treated with carnitine in an adult. Journal of neurology, neurosurgery, and psychiatry, 1996, Volume: 61, Issue:2 Topics: Adult; Anticonvulsants; Carnitine; Epilepsy; Female; Hepatic Encephalopathy; Humans; Liver; Valproic	1996
Fatal liver failure associated with valproate therapy in a patient with Friedreich's disease: review of valproate hepatotoxicity in adults. Epilepsia, 1999, Volume: 40, Issue:7 Topics: Adolescent; Adult; Chemical and Drug Induced Liver Injury; Comorbidity; Epilepsy; Fatal Outcome; Fem	1999
Hepatic encephalopathy associated with combined clozapine and divalproex sodium treatment. Journal of clinical psychopharmacology, 1997, Volume: 17, Issue:2 Topics: Adult; Clozapine; Drug Interactions; Enzyme Inhibitors; Female; Hepatic Encephalopathy; Humans; Sero	1997
Detection by HPLC-ICP of metallothionein in serum of an epileptic child with valproate-associated hepatotoxicity. Journal of trace elements and electrolytes in health and disease, 1992, Volume: 6, Issue:4 Topics: Blood Proteins; Child; Chromatography, High Pressure Liquid; Copper; Epilepsy; Hepatic Encephalopath	1992
[Irreversible valproate-associated liver failure]. Monatsschrift Kinderheilkunde : Organ der Deutschen Gesellschaft fur Kinderheilkunde, 1992, Volume: 140, Issue:12 Topics: Dandy-Walker Syndrome; Hepatic Encephalopathy; Humans; Infant; Liver; Liver Function Tests; Male; Me	1992
Treatment of valproic acid-associated hepatic failure with orthotopic liver transplantation. The Annals of pharmacotherapy, 1992, Volume: 26, Issue:1 Topics: Adult; Female; Hepatic Encephalopathy; Humans; Liver Transplantation; Necrosis; Risk Factors; Valpro	1992
A suspected case of late-onset sodium-valproate-induced hepatic failure. Neuropediatrics, 1987, Volume: 18, Issue:2 Topics: Adolescent; Drug Therapy, Combination; Epilepsy; Hepatic Encephalopathy; Humans; Liver; Male; Valpro	1987
[Fatal hepatic failure in a normally developed 5-year-old boy caused by VPA monotherapy]. Monatsschrift Kinderheilkunde : Organ der Deutschen Gesellschaft fur Kinderheilkunde, 1987, Volume: 135, Issue:6 Topics: Chemical and Drug Induced Liver Injury; Child, Preschool; Epilepsies, Partial; Epilepsy, Absence; He	1987

valproic acid and Hepatic Encephalopathy