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  • Title: Hyperammonemic encephalopathy related to valproate, phenobarbital, and topiramate synergism.
    Author: Gomez-Ibañez A, Urrestarazu-Bolumburu E, Viteri-Torres C.
    Journal: Epilepsy Behav; 2011 Aug; 21(4):480-2. PubMed ID: 21700501.
    Abstract:
    We present a woman with epilepsy secondary to a lesion in the left frontal lobe. She developed episodes of disorientation and behavioral changes. She was taking valproic acid (1500 mg/day), topiramate (200 mg/day), and phenobarbital (100 mg/day). During an episode, the EEG revealed moderate encephalopathy and ammonia levels were increased (195 μg/dL, reference range: 11-60 μg/dL). Episodes ceased after withdrawal of valproic acid.
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