USE OF VALPROIC ACID FOR THE TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN ACQUIRED BRAIN INJURIES

Abstract

Acquired brain injuries are often accompanied by a series of neuropsychiatric disorders. A wide range of pharmacological agents are used to treat neuropsychiatric symptoms. However, a more indepth review of the agents used indicates that there are in fact relatively few procedures recommended for use. Anticonvulsants including valproic acid, are of particular interest. This research aimed to assess the efficacy and safety of valproic acid, as based on a naturalistic observation of patients with various forms of acquired brain injury and who had displayed neuropsychiatric symptoms. The study group consisted of individuals (N = 43) who were treated with valproic acid as the first choice of drug. Both the initial dose and its size during further treatment, as well as the treatment method, were determined based on medical indications. The mental state of the patients was assessed twice: at the time of enrolment for the study and after 12 months. The Cohen-Mansfield Agitation Inventory (CMAI) was used for the assessment. In addition, the degree of cognitive dysfunction was assessed during the baseline study using the MMSE scale. Eventually, 24 individuals were accepted for statistical analysis. They were re-examined after 12 months and took only valproic acid during that period. 24 out of 43 individuals qualified for the study completed the 12-month observation period. 11 respondents were excluded from the study due to their inappropriate tolerance. The reported side effects were of a temporary nature (except for hair loss) and of a mild or moderate intensity. It was observed that aggressive and impulsive behaviours were significantly reduced in the study group. The positive therapeutic effect concerned all categories in the CMAI scale, except for verbal aggression. The therapeutic effect of the valproic acid was varied depending on the degree of cognitive impairments. Statistical significance for higher MMSE scores was obtained only for the category of non-aggressive verbal disorders. On the other hand, in the case of lower MMSE scores a significant reduction was observed both in the categories of non-aggressive and aggressive physical behaviours, as well as for the overall CMAI scale result. The results obtained seem to indicate a satisfactory efficacy and acceptable tolerance of valproic acid in the treatment of the neuropsychiatric symptoms accompanying acquired brain injuries.