Massive valproic acid overdose, a misleading case

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Seizures are often attributed to a low plasma concentration of antiepileptic drugs, although sometimes it can be due to a high plasma concentration of the antiepileptic drug. This case report describes a very severe valproic acid intoxication including paradoxical seizures, which was initially held for a subtherapeutic valproic acid treatment. Applied treatment strategy based on available evidence is discussed. A more careful clinical evaluation at admission might have guided the treating physicians to the right diagnoses from the start. The important lesson is that several antiepileptic medicines, as valproic acid, can cause seizures in overdose.

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