{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:35:33Z","timestamp":1776353733212,"version":"3.51.2"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Brain atrophy associated with valproate therapy is known from single case reports and is frequently accompanied by cognitive deterioration. We present a case series of incidental findings of brain volume loss in children treated with valproate and employed automatic brain volumetry to assess the effect size of volume loss. 3D T1w datasets were automatically segmented into white matter, gray matter, and cerebrospinal fluid using the SPM\u201012 algorithm. Respective volumes of cerebrum and cerebellum were read out and normalized to the total intracranial volume. We identified six patients (median age 148.5 [85\u2013178] months) who had received valproate for a median time of 5 (2\u201323)\u2009months prior to MRI in which a loss of brain volume was noted. None had reported the occurrence of new clinical symptoms. Volumetry showed a volume loss of up to 28% for cerebral GM, 25% for cerebellar GM, 10% for cerebral WM, and 20% for cerebellar WM. A volume loss of &gt;5% in at least one of the subvolumes was found in all patients, with the more prominent volume loss in the cerebrum and in gray matter. In one patient, post\u2010valproate MRI was available and showed normalization of brain volume. Our case series indicates that valproate therapy might be associated with an asymptomatic volume loss of brain parenchyma in children with epilepsy and that this volume loss is assessable with automatic volumetry.<\/jats:p>","DOI":"10.1002\/epi4.12807","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T08:32:06Z","timestamp":1691742726000},"page":"1581-1587","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Valproate associated brain volume\u2010loss in pediatric epilepsy\u2014A case series"],"prefix":"10.1002","volume":"8","author":[{"given":"Johanna","family":"Umlauf","sequence":"first","affiliation":[{"name":"Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Rau","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"},{"name":"Department of Diagnostic and Interventional Radiology, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5869-1110","authenticated-orcid":false,"given":"Theo","family":"Demerath","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Bast","sequence":"additional","affiliation":[{"name":"Epilepsy Center Kork  Kehl Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Sch\u00f6nberger","sequence":"additional","affiliation":[{"name":"Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"},{"name":"Freiburg Epilepsy Center, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-4807","authenticated-orcid":false,"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg Germany"},{"name":"Alberta Children's Hospital, Alberta Children's Research Institute, Hodgekiss Brain Institute, Section of Pediatric Neurology University of Calgary  Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1601-5384","authenticated-orcid":false,"given":"Kerstin A.","family":"Klotz","sequence":"additional","affiliation":[{"name":"Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center\u2013University of Freiburg, Faculty of Medicine University of Freiburg  Freiburg 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