DGI-079 Valproic Acid and Behaviour Disorders: Observation of Efficiency and Toxicity in a Cognitive-Behavioral Unit. (12th March 2013) - Laborde, C Rouzaud
Abstract : Background: In order to limit neuroleptic use in the elderly, because of cardiovascular events, specialists in charge of behaviour disorders don't have many therapeutic options in cognitive-behavioural units (CBU). Purpose: Valproic acid (VPA) is an anticonvulsant and/or a mood stabiliser that can be used in a behavioural way in CBU. One side effect of VPA is hyperammonaemia, which can lead to sedation and changes in behaviour or personality. Materials and Methods: Inclusion criteria were opposition, agitation, aggressiveness or impulsiveness. Ammoniemia levels were assessed before starting the VPA, between 2 and 4 days and after 5 days with VPA. For each person included, Cockroft's creatinine clearance, medical background and neuroleptic co-prescriptions were identified. Results are presented with mean±SEM. Results: The population was defined by an average age of 79.3 y ±1.74, a sex ratio of 15 men for 6 women; a creatinine clearance of 65.4 mL/min ± 8.9, no patients had liver troubles or a history of epilepsy. 21 patients received VPA in the CBU, for at least one of the following indications: opposition (n = 9), agitation (n = 13), aggressiveness (n = 16) or impulsiveness (n = 6). 9/21 patients came out of the CBU with VPA (42.85%), 13/21 without VPA (61.9%), 5/21 with a neuroleptic (23.8%) and 8/21 without VPA or a neuroleptic (38.1%). Ammoniemia rates at D-1, between D2 and D4 and after D5 were respectively 47.47 µM ± 3.71, 51.4 µM ± 6.43 and 63.76 µM ± 4.95. Response rate to VPA was 55% (5/9 patients) for opposition, 37.5% (6/16) for aggressiveness, 38% (5/13) for agitation and 66.6% (4/6) for impulsiveness. Conclusions: Those results show that only one of every two patients with VPA were responders, and average ammoniemia increases during treatment. However, 100% of patients going out with VPA didn't have any neuroleptics and for 33%, VPA contributed to stopping neuroleptics. No conflict of interest.