Abstract：
BACKGROUND: Valproic acid (VPA) is a prevalent antiseizure medication (ASM) used to treat epilepsy. Valproate-related hyperammonemic encephalopathy (VHE) is a type of encephalopathy that can occur during neurocritical situations. In VHE, the electroencephalogram (EEG) displays diffuse slow waves or periodic waves, and there is no generalized suppression pattern.
METHODS: We present a case of a 29-year-old female with a history of epilepsy who was admitted for convulsive status epilepticus (CSE), which was controlled by intravenous VPA, as well as oral VPA and phenytoin. The patient did not experience further convulsions but instead developed impaired consciousness. Continuous EEG monitoring revealed a generalized suppression pattern, and the patient was unresponsive. The patient\'s blood ammonia level was significantly elevated at 386.8 μmol/L, indicating VHE. Additionally, the patient\'s serum VPA level was 58.37 μg/ml (normal range: 50-100 μg/ml). After stopping VPA and phenytoin and transitioning to oxcarbazepine for anti-seizure and symptomatic treatment, the patient\'s EEG gradually returned to normal, and her consciousness was fully restored.
CONCLUSIONS: VHE can cause the EEG to display a generalized suppression pattern. It is crucial to recognize this specific situation and not to infer a poor prognosis based on this EEG pattern.
METHODS: We present a case of a 29-year-old female with a history of epilepsy who was admitted for convulsive status epilepticus (CSE), which was controlled by intravenous VPA, as well as oral VPA and phenytoin. The patient did not experience further convulsions but instead developed impaired consciousness. Continuous EEG monitoring revealed a generalized suppression pattern, and the patient was unresponsive. The patient\'s blood ammonia level was significantly elevated at 386.8 μmol/L, indicating VHE. Additionally, the patient\'s serum VPA level was 58.37 μg/ml (normal range: 50-100 μg/ml). After stopping VPA and phenytoin and transitioning to oxcarbazepine for anti-seizure and symptomatic treatment, the patient\'s EEG gradually returned to normal, and her consciousness was fully restored.
CONCLUSIONS: VHE can cause the EEG to display a generalized suppression pattern. It is crucial to recognize this specific situation and not to infer a poor prognosis based on this EEG pattern.
摘要：
背景：丙戊酸（VPA）是一种常用的抗癫痫药物（ASM），用于治疗癫痫。丙戊酸相关性高血氨脑病（VHE）是一种在神经危重情况下可能发生的脑病。在VHE,脑电图（EEG）显示弥散慢波或周期性波，并且没有广义的抑制模式。
方法：我们介绍一例29岁女性，有癫痫史，因惊厥性癫痫持续状态（CSE）入院，由静脉注射VPA控制，以及口服VPA和苯妥英。患者没有进一步的抽搐，而是出现了意识障碍。连续脑电图监测显示了一种普遍的抑制模式，病人没有反应。患者血氨水平显著升高至386.8μmol/L,表示VHE。此外,患者血清VPA水平为58.37μg/ml(正常范围:50-100μg/ml).停药VPA和苯妥英钠后转用奥卡西平抗癫痫及对症治疗,患者的脑电图逐渐恢复正常，她的意识完全恢复了.
结论：VHE可导致EEG显示出普遍的抑制模式。至关重要的是要认识到这种具体情况，而不是根据这种EEG模式推断不良预后。
方法：我们介绍一例29岁女性，有癫痫史，因惊厥性癫痫持续状态（CSE）入院，由静脉注射VPA控制，以及口服VPA和苯妥英。患者没有进一步的抽搐，而是出现了意识障碍。连续脑电图监测显示了一种普遍的抑制模式，病人没有反应。患者血氨水平显著升高至386.8μmol/L,表示VHE。此外,患者血清VPA水平为58.37μg/ml(正常范围:50-100μg/ml).停药VPA和苯妥英钠后转用奥卡西平抗癫痫及对症治疗,患者的脑电图逐渐恢复正常，她的意识完全恢复了.
结论：VHE可导致EEG显示出普遍的抑制模式。至关重要的是要认识到这种具体情况，而不是根据这种EEG模式推断不良预后。
