Valproate Use Linked to Brain Volume Reduction in Epilepsy Patients

Recent study unveiled important findings about the impact of valproate (VPA) use on the brain volume of individuals with idiopathic generalized epilepsy. The crucial results of the extensive study were published in Epilepsia Journal.

The study employed voxel-based morphometry on magnetic resonance imaging (MRI) and focused on 112 patients currently using VPA (VPA+ group), 81 not using VPA (VPA– group), and 120 healthy subjects for comparison.

The findings indicated significant gray matter (GM) volume reduction in the VPA+ group in various brain regions, including the bilateral cerebellum, hippocampus, insula, caudate nucleus, medial frontal cortex/anterior cingulate cortex, primary motor/premotor cortex, medial occipital cortex, and anteromedial thalamus. When compared to the control group, the VPA– group also exhibited GM volume reduction in the anteromedial thalamus and right hippocampus/temporal cortex.

The study found distinctive differences the VPA+ group, when compared to the VPA– group which showed more extensive GM volume reduction in the bilateral cerebellum, primary motor/premotor cortex, and medial frontal cortex/anterior cingulate cortex.

These findings found the potential adverse effects of VPA on brain structure, particularly in the frontal cortex and cerebellum. The study suggests that the use of VPA may contribute to cortical thinning and GM volume reduction, urging caution while interpreting morphometric MRI studies involving individuals taking VPA.

The study emphasizes the importance of considering VPA use as a potential confounding factor in studies exploring brain morphometry. Understanding these associations is crucial not only for clinicians prescribing VPA but also for researchers aiming to accurately interpret MRI data in epilepsy studies. Further investigations are imperative to validate the clinical implications and long-term effects of these structural changes that were observed in epilepsy patients using VPA.

Source:

Shin, J. H., Song, M. J., & Kim, J. H. (2023). Valproate use associated with frontal and cerebellar gray matter volume reductions: A voxel‐based morphometry study. In Epilepsia. Wiley. https://doi.org/10.1111/epi.17825