Open AccessWaddling Gait: A complication of valproate therapy and a thought beyond vitamin D deficiency
Author(s) -
Amit Kumar Sharma,
Siddhartha Sinha,
Amit Narang,
Dushyant K. Chouhan,
Sumit Gupta
Publication year - 2020
Publication title -
sultan qaboos university medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.258
H-Index - 27
eISSN - 2075-0528
pISSN - 2075-051X
DOI - 10.18295/squmj.2020.20.01.016
Subject(s) - medicine , myopathy , ataxic gait , valproic acid , pediatrics , proximal muscle weakness , muscle weakness , weakness , epilepsy , surgery , ataxia , psychiatry , muscle biopsy , biopsy
Proximal muscle weakness is a common presentation in paediatric-orthopaedic clinics and is frequently paired with a vitamin D deficiency diagnosis. Recently, side effects of the extensive use of antiepileptic and antipsychotic drugs such as sodium valproate in childhood disorders are being documented. Sodium valproate causes a time-dependent, drug-induced proximal myopathy. We report a 13-year-old female patient who presented at the Orthopaedic Outpatient Department at Lady Hardinge Medical College, New Delhi, India, in 2019 with an abnormal gait. The patient was taking a combination therapy of sodium valproate, risperidone and trihexyphenidyl for absence seizures and a mood disorder. Following clinical investigations, the patient was diagnosed with proximal myopathy. As a result of elevated serum alkaline phosphatase and creatine kinase myocardial band levels, sodium valproate was replaced with ethosuximide and a carnitine supplementation was prescribed. The patient fully recovered and regained full mobility. Proximal myopathy had been incorrectly managed and assumed to be caused by a vitamin D deficiency.