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Borbath and coworkers [82] reported the case of a 51-year-old woman who received 10 mg/kg VPA daily to prevent seizures after a neurosurgical procedure, and who developed VHE (ammonia concentration 234 mol/l) without any sign of hepatic dysfunction

90 Supporting adherence through gradual dose titration, proactive side effect management, patient education, and regular follow-up may help sustain treatment benefits over time, although broader system-level efforts will be needed to improve long-term affordability and access

the picture in people without these conditions is less settled Physical risks psychiatry should be watching: Muscle loss: 10 to 25% of fat-free mass, particularly at higher doses