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As children with SMA may have a limited carnitine synthetic capacity due to significantly diminished skeletal muscle mass, and VPA is known to inhibit carnitine transport and deplete carnitine levels by binding to VPA metabolites, we elected to combine VPA therapy with sufficient supplemental carnitine to avoid concerns about a confounding effect of carnitine depletion

Some individuals may experience sulfur sensitivity, while others might face detox reactions, especially if their detoxification pathways are sluggish

et al., 2012)