Valproic Acid Treatment for Spinal Muscular Atrophy Patient with Abnormal Electroencephalogram Findings

Abstract

Background: Valproic Acid (VPA), an anticonvulsant, is a histone deacetylase inhibitor that can increase the Survival Motor Neuron (SMN) level in Spinal Muscular Atrophy (SMA) patients and anticipated to be an effective therapeutic agent for SMA.Patient description: VPA was administered for SMA to a 6-year-old female who showed non-symptomatic abnormal electroencephalogram findings, as well as SMA signs and symptoms. Although the VPA concentration of our patient remained in a low range, electroencephalogram abnormalities disappeared within 10 months after starting administration. On the other hand, clinical signs and symptoms of SMA, respiratory function values, and modified Hammersmith Functional Motor Scale results showed no remarkable changes. We also analyzed survival motor neuron (SMN) transcripts and splicing factor transcripts, such as splicing factor 2/alternative splicing factor (SF2/ASF) and heterogeneous nuclear ribonucleoprotein A1 (hnRNPA1), using quantitative real-time PCR assays performed before and after VPA treatment. The amounts of the FL-SMN, total-SMN, ASF/SF2, and hnRNPA1 transcripts showed an increasing tendency, whereas that of Δ7-SMN was decreased.Conclusion: Our findings indicate a discrepancy between SMN transcript response, and improvements in SMA symptoms and signs following VPA administration in some SMA patients.