[Side effects of antiepileptic therapy. Study of 197 cases]

A study of 197 epileptic outpatients consecutively observed by one Neurologist allowed a prospective study of the side effects of antiepileptic drugs. This study shows essentially that a clinical improvement comparable to that generally reported can be obtained with side effects limited in their number and intensity. The main principle is the routine search of these effects which are not always spontaneously mentioned by the patients, especially intellectual slowness and loss of sexual activity. The detection of the side effects through history and physical examination is far more fruitful than are plasma concentrations of drugs which can be doubly misleading: some plasma concentrations lower than recognized therapeutical levels are efficient however while others are higher and nevertheless necessary and well tolerated. Among the side effects specific to certain antiepileptic drugs, shoulder-hand syndrome due to phenobarbital was noted in 10 per cent of the cases. Furthermore, the frequency of scapulo-humeral periarthritis was significantly higher in the epileptic group than in the controls. Dupuytren's disease was less frequent (8 per cent) and the difference with the controls was not significant. Among the non-specific side effects, nystagmus is a somewhat useful sign in treatments by phenytoin but as with drugs dosages, it must be weighed within the whole clinical picture.