EMPACT syndrome associated with phenobarbital

Area of Science:

• Neuro-oncology
• Dermatology
• Clinical Pharmacology

Background:

• Intracranial malignancies frequently cause seizures, necessitating anticonvulsant therapy.
• Phenytoin is a common anticonvulsant used to manage seizure activity in patients with brain tumors.
• Cranial radiation therapy is a standard treatment for unresectable brain tumors.

Observation:

• The combination of phenytoin and cranial radiation therapy can induce a severe mucocutaneous reaction known as EMPACT syndrome.
• Two cases of EMPACT syndrome were observed.
• These cases involved the use of phenobarbital, an alternative anticonvulsant, instead of phenytoin.

Findings:

• Phenobarbital, in conjunction with cranial radiation therapy, can also precipitate EMPACT syndrome.
• This suggests that the syndrome's etiology may involve a broader class of anticonvulsants or a shared mechanism with radiation.

Implications:

• Clinicians should be vigilant for EMPACT syndrome when patients receive cranial radiation therapy, regardless of the specific anticonvulsant used.
• This finding expands the known triggers for EMPACT syndrome, necessitating careful monitoring for mucocutaneous adverse events.
• Further research is warranted to elucidate the precise mechanisms underlying radiation-induced hypersensitivity reactions involving anticonvulsants.