REVERSIBLE DEMENTIA AND APPARENT BRAIN ATROPHY DURING VALPROATE THERAPY

Two children developed severe cognitive and behavioral deterioration s uggestive of a degenerative disease while being treated with sodium va lproate for idiopathic, localization-related epilepsy with centrotempo ral spikes. Magnetic resonance imaging revealed marked central and gen eralized cortical and cerebellar atrophy. In both patients, clinical s ymptoms and signs cleared in a few weeks following valproate withdrawa l. The magnetic resonance imaging appearance improved within 3 months in 1 of the patients and normalized in both after 6 and 12 months. No metabolic changes were associated with the clinical or imaging abnorma lities. Although the mechanism of this rare idiosyncratic complication of valproate therapy is unknown, we advocate discontinuing valproate therapy in all epileptic patients with neuromental deterioration or br ain atrophy of unknown etiology.