Waddling gait : a complication of valproate therapy and a thought beyond vitamin D deficiency

Abstract EN

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