A 14-year-old girl is referred for evaluation of episodes where she suddenly stops responding, stares blankly for 10–20 seconds, then resumes normal activity without any postictal confusion. Her parents notice she sometimes performs purposeless lip-smacking during these episodes. EEG confirms the diagnosis. She is subsequently started on valproate. Six months later, she reports menstrual irregularities and weight gain, and her gynecologist detects polycystic ovaries on ultrasound. What is the most likely cause of the new findings?
- A Normal adolescent hormonal variation
- B Valproate-induced polycystic ovarian syndrome ✓
- C Carbamazepine-induced hormonal disruption
- D Complex partial seizure effect on hypothalamus
Explanation
Valproate (sodium valproate) is associated with polycystic ovarian syndrome (PCOS), hyperandrogenism, menstrual irregularities, and weight gain — particularly in young women and adolescents. The mechanism involves insulin resistance, increased androgen synthesis, and possibly direct effects on ovarian steroidogenesis. Because of this risk, many guidelines recommend alternative antiepileptics (lamotrigine, levetiracetam) for girls of reproductive age when clinically appropriate. In psychiatry, valproate is used as a mood stabilizer in bipolar disorder and this same adverse effect applies.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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