Related Experiment Videos
Kinetics of CSF phenytoin in children
Insights
Phenytoin effectively treats status epilepticus by entering the brain. This study found therapeutic cerebrospinal fluid (CSF) phenytoin levels above 2 mcg/ml correlate with positive outcomes in children.
Area of Science:
- Pharmacology
- Neurology
- Pediatrics
Background:
- Intravenous phenytoin is crucial for treating status epilepticus.
- Phenytoin's efficacy depends on its rapid brain penetration.
- Limited data exists on phenytoin serum and CSF concentrations in pediatric patients.
Purpose of the Study:
- To investigate the correlation between serum and cerebrospinal fluid (CSF) phenytoin concentrations in children.
- To assess the clinical applicability of CSF phenytoin data in pediatric treatment.
Main Methods:
- Seven pediatric patients (2-11 years) treated with phenytoin were studied.
- CSF samples were collected via lumbar puncture (9 times in 6 patients).
- One patient had continuous CSF phenytoin monitoring via an intraventricular catheter.
Main Results:
- The CSF/serum phenytoin concentration ratio was 0.16 ± 0.08.
- CSF phenytoin levels gradually increased as serum levels decreased within 8 hours.
- Therapeutic outcomes correlated with CSF phenytoin levels > 2 mcg/ml.
- One case of phenytoin intoxication-induced coma was linked to a high CSF concentration (6 mcg/ml).
Conclusions:
- CSF phenytoin concentrations are a valuable indicator of therapeutic efficacy and toxicity in children.
- Monitoring CSF phenytoin levels can guide treatment adjustments for status epilepticus in pediatric patients.
Abstract:
The efficacy of intravenous phenytoin for the treatment of status epilepticus is related to the rapid entry of phenytoin into brain parenchyma. There is no information concerning the correlation between phenytoin serum and CSF concentrations in children, and the application of CSF data to clinical use. We report 7 children (2-11 yrs) who were treated or exposed to phenytoin in doses between 10.5-230 mg/kg. Lumbar puncture was performed 9 times in 6 of the patients. In one patient, an intraventricular catheter permitted successive assessment of CSF phenytoin concentrations. The ratio of CSF/serum phenytoin concentrations was 0.16 +/- 0.08, with gradual increase over the first 8 hours as the serum phenytoin concentration decreased. There was good correlation between therapeutic outcome and CSF phenytoin levels higher than 2 mcg/ml. In one patient the coma state secondary to phenytoin intoxication was associated with high CSF concentration (6 mcg/ml).