Behavioral disturbances after initiation of valproate in a young child: Alternate explanations possible?

Valproate is one of the commonly used medications for the treatment of seizures. Though this medication is used frequently in the treatment of behavioral abnormalities and aggressive behaviors, rarely it has been associated to cause irritability and other behavioral problems. Access of parents to unsubstantiated easily accessible medical literature in the internet may predispose them to ascribe behavioral problems to medications. We present a case of a 3½-year-old child who was recently started on valproate after seizures and had presented with behavioral problems in the form of irritability, tantrums, and outbursts mainly in the family context after initiation of valproate. We discuss alternate possible explanations for such behavioral problems.