Anticonvulsant-induced dyskinesias: a comparison with dyskinesias induced by neuroleptics.

Chadwick, David; Reynolds, E. H.; Marsden, C. D.

doi:10.1136/jnnp.39.12.1210

Cited by 149 publications

(47 citation statements)

References 22 publications

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“…Indeed, nonepileptic myoclonus in pediatric and adult patients receiving CBZ has been reported by many other authors (82)(83)(84), although in some cases (83) the lack of EEG data does not allow exclusion of an epileptic origin of the condition. In two children with benign rolandic epilepsy recently described by Guerrini et al (40), negative myoclonus aggravated by CBZ was clearly epileptic in origin.…”

Section: Carbamazepinementioning

confidence: 95%

Antiepileptic Drugs as a Cause of Worsening Seizures

Perucca

Gram

Avanzini³

et al. 1998

Epilepsia

499

329

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Summary:Purpose: Although the paradoxical ability of antiepileptic drugs (AEDs) to increase seizure activity has been recognized for decades, the underlying mechanisms are poorly understood and few systematic studies have addressed this problem. This article is intended to provide a critical review of available literature on this topic.Methods: Information was collected by means of computerized literature searches, screening of journals and textbooks, and consultation with colleagues. Mechanisms which potentially might precipitate underlying drug-induced exacerbation of seizures were considered based on available pharmacologic and clinical knowledge.

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Section: Carbamazepinementioning

confidence: 95%

Antiepileptic Drugs as a Cause of Worsening Seizures

Perucca

Gram

Avanzini³

et al. 1998

Epilepsia

499

329

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“…3 Earlier studies have reported the association of phenytoin use with transient chorea, athetosis, myoclonus, orofacial abnormality and dystonia. 4 Other marked symptoms like abnormal gait and ataxia are often accompanied by nystagmus, dysarthria (slurring of speech), suggestive of phenytoin's adverse effect on the cerebellum. 5 Various cases of cerebellar atrophy have been reported on longterm use of phenytoin, even at therapeutic doses.…”

Section: Discussionmentioning

confidence: 99%

Case Report on Phenytoin Induced Cerebellar Syndrome

Satheesh¹,

K²,

Antony³

2018

IJOPP

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Phenytoin, an anticonvulsant extensively used to control generalized tonic-clonic seizures as well as simple and complex partial seizures, has a stabilizing influence on neuronal membrane. Phenytoin acts by prolonging the inactivated state of sodium channel, thereby extending the refractory period of neurons and limiting the repetitive firing of action potentials. Bioavailability of phenytoin fluctuates widely on the account of pharmacokinetic variability. Consequently, the narrow therapeutic window of phenytoin frequently causes adverse effects and toxicity. Phenytoin at higher doses is associated with various vestibular and cerebellar side effects like motor ataxia, muscle spasms, psychoses and visual disturbances. Long term use of phenytoin at therapeutic and toxic levels can lead to cerebellar atrophy. However, phenytoin-induced cerebellar syndrome is reversible on timely withdrawal of the medication. Regular monitoring of plasma concentrations, accurate dosing, and medication adherence to treatment regimens are important. Here, we report a case of phenytoin-induced cerebellar syndrome presenting with behavioral abnormalities, paraparesis and visual impairment. The patient's condition improved upon gradually tapering the dose, followed by termination of phenytoin therapy and substitution with carbamazepine. This report emphasizes on the importance of regular monitoring of plasma drug concentration, accurate dosing of drugs having a narrow therapeutic index, and identification of noncompliance in patients treated with phenytoin.

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“…7 Chalhub et al 8 identified the connection between phenytoininduced dystonia with choreoathetosis in two epileptic children.…”

Section: Discussionmentioning

confidence: 99%

Phenytoin induced dystonia

et al. 2018

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The abnormalities of dopaminergic activity in the basal ganglia have been emphasized to be effective in dystonia. We hereby report a case of a 2.5-year-old male patient who presented with tonic-clonic sezures and who developed dystonia after being given phenytoin. Biperidene hydrochloride was administered intramuscularly; primidone was added to the treatment regimen. After a 7-day-follow-up at the hospital, the patient had no dystonia and was discharged.Key words: epilepsy, phenytoin, dystonia.Although the underlying neuro-chemical pathology is not known, it has been emphasized that abnormalities seen at dopaminergic activity in the basal ganglions are effective in dystonia. It is mostly the side effect of classical antipsychotics; it may also emerge after taking medicines such as metoclopramide, which are effective on the dopaminergic pathway. 1 The acutely starting extrapyramidal symptoms in childhood are accepted as an urgent medical condition and they need to be alleviated as soon as possible.Phenytoin, which is a derivative of hydantoin, is widely used in the treatment of tonic-clonic seizure due to its anticonvulsant activity without a sedative effect. In our case, acute dystonia developed approximately 12 hours following phenytoin infusion. Case ReportA 2.5-year-old-male patient presented to the hospital with convulsions lasting for approximately 5 minutes and repeating 4-5 times in half an hour. The patient, born through spontaneous vaginal delivery (2,900 g), had normal development stages. His 11-year-old brother was suffering from epilepsy, diagnosed at the age of four; and was on sodium valproate therapy. Since the patient had an epileptic attack 2 months ago, brain MR was taken to exclude intracranial pathology. Brain MRI of the patient had demonstrated a slight increase at the centrum semioviale level and bilateral forceps major levels in the white matter on T2-weighed images and flair images. It was considered that myelinization had not completed its development in the white matter. As a result of detecting bilateral generalized sharp wave paroxysm in his electroencephalography (EEG), sodium valproate 20 mg was begun.After 1-month of sodium valproate-treatment, the patient re-presented to the emergency department due to generalized tonic-clonic seizures. Rectal diazepam (10 mg) was administered, which was followed by phenytoin (20 mg/kg). The patient had status epilepticus, and was transferred to the intensive care unit and midazolam infusion was started. Afterwards, the dose of midazolam was tapered gradually as his seizures subsided; an additional dose of phenytoin (10 mg/kg) was administered.His physical examination revealed: temperature 36.7ºC, blood pressure 95/55 mm Hg, pulse rate 95/min., oxygen saturation 98%; frontal fontanelle was closed, light reaction was positive on both sides with equal sized pupils, and no neck stiffness and pathological reflex. Deep tendon reflexes were normal. Muscle strength was 5/5 for all extremities. Laboratory examination revealed: glucose 90 mg/dl, urea 33 mg...

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Anticonvulsant-induced dyskinesias: a comparison with dyskinesias induced by neuroleptics.

Cited by 149 publications

References 22 publications

Antiepileptic Drugs as a Cause of Worsening Seizures

Antiepileptic Drugs as a Cause of Worsening Seizures

Case Report on Phenytoin Induced Cerebellar Syndrome

Phenytoin induced dystonia

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