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Choreoathetosis during phenytoin treatment
Acta Medica Scandinavica
|January 1, 1977
Summary
Phenytoin can cause movement disorders like choreoathetosis, even at low serum concentrations. This highlights the need to consider phenytoin toxicity in epilepsy patients with neurological deterioration.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Epilepsy management often involves antiepileptic drugs like phenytoin.
- Phenytoin is generally considered safe within therapeutic serum concentrations.
Observation:
- A patient with epilepsy on phenytoin monotherapy developed choreoathetosis and orofacial dyskinesias.
- Movement disorders resolved upon phenytoin withdrawal and recurred upon re-challenge.
- Serum phenytoin levels remained low and within the therapeutic range throughout treatment.
Findings:
- The patient exhibited atypical phenytoin intoxication symptoms, delaying diagnosis.
- Autopsy revealed localized encephalomalacia in the corpus striatum.
- Phenytoin's pathogenic action, potentially exacerbated by pre-existing brain lesions, is implicated.
Implications:
- Phenytoin should be suspected in epilepsy patients presenting with unexplained neurological or mental deterioration.
- This case underscores the importance of considering drug toxicity even with normal therapeutic drug levels.
- Further investigation into phenytoin's neurotoxic mechanisms and risk factors is warranted.