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Valproate-induced hyperammonaemic encephalopathy In chronic VPA dosing hyperammonaemia occurs in nearly 50% of patients, but this remains asymptomatic in almost 50% of cases [39]

doi: 10.1016/j.conb.2006.09.004

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One thing that could cause this decline is a decrease in blood flow through your body, a process called intermittent claudication

Retrograde neuronal death after nerve injury is largely due to diminished neurotrophic signaling from remaining Schwann cells and target structures [57]
