bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2025-2-951bekhterev-1133Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWВальпроат-индуцированные нарушения метаболизма дофамина и развитие вальпроат-индуцированного паркинсонизма: новый взгляд на профилактику и диагностикуValproate-induced disorders of dopamine metabolism and the development of valproate-induced parkinsonism: a new perspective on prevention and diagnosishttps://orcid.org/0000-0002-2840-837XШнайдерН. А.ShnayderN. A.

Шнайдер Наталья Алексеевна — д.м.н., профессор, главный научный сотрудник Института персонализированной психиатрии и неврологии; ведущий научный сотрудник центра коллективного пользования «Молекулярные и клеточные технологии»

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

660022, Красноярск, ул. Партизана Железняка, 1

Natania A. Shnayder

St. Petersburg; Krasnoyarsk

naschnaider@yandex.ruhttps://orcid.org/0000-0001-8279-4198ГречкинаВ. В.GrechkinaV. V.

Гречкина Виолетта Владимировна — младший научный сотрудник Института персонализированной психиатрии и неврологии 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Violetta V. Grechkina

St. Petersburg

grechkina.vv@mail.ruhttps://orcid.org/0000-0002-4186-5911КиссинМ. Я.KissinM. Y.

Киссин Михаил Яковлевич — д.м.н., профессор кафедры психиатрии и наркологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Mikhail Y. Kissin

St. Petersburg

kissin.m@yandex.ruhttps://orcid.org/0000-0003-1874-9434НасыроваР. Ф.NasyrovaR. F.

Насырова Регина Фаритовна — д.м.н., главный научный сотрудник, руководитель Института персонализированной психиатрии и неврологии;  профессор кафедры  психиатрии, общей и клинической психологии 

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

300012, г.Тула, пр.Ленина, д.92

Regina F. Nasyrova 

St. Petersburg; Tula 

regina_nmrcpn@mail.ruНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева; Красноярский государственный медицинский университет имени В.Ф. Войно-ЯсенецкогоРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; V.F. Voyno-Yasenetsky Krasnoyarsk State Medical UniversityRussian FederationНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. БехтереваРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and NeurologyRussian FederationПервый Санкт-Петербургский государственный медицинский университет им. И.П. ПавловаРоссияPavlov First St. Petersburg State Medical UniversityRussian FederationНациональный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева; Тульский государственный университетРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; Tula State UniversityRussian Federation2025300620255924051Copyright © Шнайдер Н.А., Гречкина В.В., Киссин М.Я., Насырова Р.Ф., 20252025Шнайдер Н.А., Гречкина В.В., Киссин М.Я., Насырова Р.Ф.Shnayder N.A., Grechkina V.V., Kissin M.Y., Nasyrova R.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/1133

Проблема вальпроат-индуцированных нежелательных реакций, включая вальпроат-индуцированный паркинсонизм, имеет высокую актуальность в связи с широким использование вальпроатов в психиатрической и неврологической практике и сложностью патогенеза нарушения дофаминергической нейротрансмиссии. К сожалению, пока не разработаны персонализированные алгоритмы для практикующих врачей, основанные на использовании современных методов фармакогеномики и фармакометаболомики вальпроат-индуцированного паркинсонизма. Наиболее важными методами диагностики и прогнозирования вальпроат-индуцированного паркинсонизма являются 1) исследование неврологического статуса (оценка моторных и немоторных симптомов лекарственного паркинсонизма); 2) терапевтический лекарственный мониторинг общей и свободной фракций вальпроевой кислоты; 3) исследование уровня токсических метаболических метаболитов вальпроевой кислоты в крови и моче; фармакогенетическое тестирование нефункциональных однонуклеотидных вариантов генов, кодирующих ключевые ферменты метаболизма и ключевые транспортные белки эффлюкса вальпроевой кислоты через гематоэнцефалический барьер.

The problem of valproate-induced adverse drug reactions, including valproate-induced parkinsonism is of high relevance due to the widespread use of valproates in psychiatric and neurological practice and the complexity of the pathogenesis of dopaminergic neurotransmission disorders. Unfortunately, personalized algorithms for practicing physicians based on the use of modern methods of pharmacogenomics and pharmacometabolomics of valproate-induced parkinsonism have not yet been developed. The most important methods of diagnosis and prognosis of valproate-induced parkinsonism are 1) investigation of neurologic status (assessment of motor and non-motor symptoms of drug-induced parkinsonism); 2) therapeutic drug monitoring of total and free fractions of valproic acid; 3) study of the level of toxic metabolic metabolites of valproic acid in blood and urine; pharmacogenetic testing of non-functional single nucleotide variants of genes encoding key metabolic enzymes and key transport proteins of valproic acid efflux across the blood-brain barrier.

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The authors declare that there are no conflicts of interest present.