Neurological effects valproate

Clonazepam is well absorbed, 95 to 98% protein bound, and extensively metabolized by CYP3A4. Clonazepam displays a wide spectrum of antiseizure activities and is one of the most potent AEDs. Side effects are common, however, and the development of tolerance is more frequent than with ethosuximide or valproate. Sedation is prominent, especially early in treatment. Drowsiness, ataxia, and behavioral changes may be disabling, but slowly Increasing its dose over a 2-week period Is recommended to minimize adverse effects. Diplopia, headaches, nystagmus, and other neurologic effects have been reported with the use of clonazepam. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Rattya J, Turkka J, Pakarinen AJ, Knip M, Kotila MA, Lukkarinen O, Myllyla VV, Isojarvi JI. Reproductive effects of valproate, carbamazepine, and oxcarbazepine in men with epilepsy. Neurology 2001 56(l) 31-6. 

In a 6-week open study of risperidone (mean dosage 4.7 mg/day) in combination with mood-stabilizing treatments (usually lithium, carbamazepine, or valproate) for the treatment of schizoaffective disorder in 102 patients, 95 of whom completed the trial, at week 4 most patients had improved symptom severity and 9.3% were completely symptom-free (35). There were no statistically significant differences between baseline and week 4 in the severity of extrapyramidal symptoms, as measured by the UKU Side-Effect Rating Scale subscale for neurological adverse effects other adverse effects included depressive symptoms (n = 13), exacerbation of mania ( n = 5), drowsiness (n = 3), and impotence (n = 2). 

Meador KJ, Loring DW, Hulihan JF, Kamin M, Karim R CAPSS-027 Study Group. Differential cognitive and behavioral effects of topiramate and valproate. Neurology 2003 60 1483-8. 

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