Clinical Evidence of Senile Choreo‐Athetosis Following Valproate Withdrawal: A Case Report

ABSTRACT An 81‐year‐old man with a 30‐year history of taking sodium valproate (800 mg/day) for epilepsy experienced an acute onset of involuntary hyperkinetic movements. This progressive condition kept him bedridden for 3 months before he visited our hospital. Upon admission, he exhibited generalized choreiform and athetotic movements and senile hearing loss. Both brain MRI and CT scans revealed no acute or chronic specific lesions. Notably, his valproate serum concentration was 8.0 mg/L, markedly below the therapeutic range of 50–100 mg/L. Since the COVID‐19 pandemic began, he has limitedly visited his primary care physician for medication refills. No epileptiform activity was identified on the electroencephalography. Given the potential link between his choreo‐athetosis and withdrawal of chronic valproate treatment, which can act as a D 2 antagonist, he was started on 50 mg of tiapride hydrochloride (a D 2 antagonist) taken thrice daily, which significantly improved his choreo‐athetosis within a week.