Sodium Valproate for Painful Peripheral Neuropathy in Diabetic Patients

Sodium valproate, an anticonvulsant discovered in 1963, has been a cornerstone in epilepsy management. It has shown potential benefits in treating painful peripheral neuropathy, particularly in diabetic patients, though evidence from small-scale trials is inconsistent. Two key studies, Agrawal and Kochar, demonstrated significant pain reduction with valproate, but only Kochar's study showed a significant difference compared to placebo. Due to limited high-quality data, current guidelines recommend other antiepileptics as first-line treatments for neuropathy, reserving valproate for treatment-resistant cases. Important side effects include hepatotoxicity, pancreatitis, teratogenicity, and weight gain, necessitating careful monitoring, especially in women of childbearing age.