Stuporous Episodes During Treatment with Sodium Valproate: Report of Seven Cases

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Abstract
Of 13 patients with complex partial seizures who experienced stuporous states during treatment with sodium valproate (VPA), 4 received VPA only, 4 VPA and phenobarbital (PB) and 5 VPA, PB and a 3rd anticonvulsant. Seven cases are described in detail. Side effects (stupor or confusion) appeared a few days after efficacious drug plasma levels were attained, persisted until therapy was readjusted and disappeared 24-72 h after VPA withdrawal. Therapeutic trials established the role of VPA in the onset of stuporous states. The adverse effects of VPA were potentiated by the concomitant administration of other anticonvulsants. Stupor was not due to VPA overdoses, and plasma concentration of the drugs were not correlated with the electroclinical signs. The EEG showed spike and wave discharges or continuous sharp .theta. and .delta. waves persisting during VPA treatment. Because all 13 stuporous, VPA-treated patients were subject to partial seizures with complex symptomatology and none were cases of generalized epilepsy, and because the disturbances of consciousness started with focal symptoms and EEG signs resembling those of spontaneously occurring symptoms and EEG signs resembling those of spontaneously occurring partial seizures, VPA given alone or in association with other antiepileptics apparently has a paradoxical epileptogenic effect in certain forms of epilepsy.