2020 Volume 90 Issue 6 Pages 132-136
Valproate sodium (VPA) -induced hypofibrinogenemia is an underrecognized condition in comparison to thrombocytopenia, which is easily identified by regular blood tests including complete blood count. Here, we report a case of epilepsy with myoclonic-atonic seizures (EMAS) which exhibited valproate-induced mild hypofibrinogenemia with petechiae. A 3-year-old boy with EMAS was referred to our hospital for seizure control. VPA was increased to 40 mg/kg/day with a blood concentration of 128.5 μg/mL (peak value), and epileptic seizures during wakefulness, including myoclonic-atonic seizures, were completely controlled. However, subtle petechiae were repeatedly noted and the blood test showed mild hypofibrinogenemia (112 mg/dL) with normal platelet count, even after decreasing VPA to 30 mg/kg/day (104.3 μg/mL). Therefore, VPA had to be lowered to 25 mg/kg/day (76.3 μg/mL), and hypofibrinogenemia as well as the subtle petechiae eventually resolved. For patients who are taking VPA and are exhibiting bleeding tendencies, it is imperative that a coagulation test be conducted even if VPA is not taken in high doses.
