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Phenytoin neuropathy: structural changes in the sural nerve.

J A Ramirez, J R Mendell, J R Warmolts

Annals of Neurology

|February 1, 1986

Summary

Long-term phenytoin use can cause reversible peripheral neuropathy, affecting nerve fibers and causing axonal shrinkage. Stopping the medication led to significant clinical and electrophysiological improvements in a patient.

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Area of Science:

Neurology
Toxicology
Pathology

Background:

Phenytoin is suspected to cause peripheral neuropathy.
Structural nerve changes associated with phenytoin-induced neuropathy are not well-characterized.

Observation:

A 47-year-old male patient presented with clinical and electrophysiological signs of peripheral neuropathy.
The patient had a 30-year history of phenytoin administration with blood levels of 31-38 µg/ml despite a 300 mg/day dose.

Findings:

Sural nerve biopsy revealed loss of large myelinated nerve fibers.
Nonrandom, clustered segmental demyelination and remyelination were observed, accompanied by axonal shrinkage.
These neuropathic changes were linked to long-term phenytoin exposure.

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Implications:

Long-term phenytoin administration can induce a reversible peripheral neuropathy.
The neuropathy is characterized by axonal shrinkage and secondary demyelination.
Cessation of phenytoin treatment resulted in patient recovery, highlighting the drug's potential neurotoxicity.