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Liver function tests annually , or more frequently if baseline abnormalities exist or if patients develop symptoms suggesting hepatobiliary disease

Answer and interpretation This is probably valproic acid induced hyperammonia encephalopathy (VHE) VHE has been reported secondary to acute VPA overdose and in chronic normal therapeutic dosing, presenting as an acute and profound decreased level of consciousness, with or without increased seizure activity this is usually in association with an increased serum ammonia level (Mock and Schwetschenau, 2008) Patients at higher risk for VHE include those with liver impairment, on multiple anticonvulsants, or have other causes of increased ammonia production

They no longer fit melanocortin receptors and cannot trigger the intended signaling cascade

Responsible use begins with ensuring eligibility