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[EEG in phenytoin intoxication (author's transl)].

P Wessely, N Mayr

    EEG-EMG Zeitschrift Fur Elektroenzephalographie, Elektromyographie Und Verwandte Gebiete
    |September 1, 1981
    PubMed
    Summary

    Phenytoin intoxication can cause reversible neurological symptoms. Electroencephalogram (EEG) changes, though nonspecific, may precede clinical signs and aid in diagnosis.

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    Area of Science:

    • Neurology
    • Clinical Neurophysiology

    Background:

    • Phenytoin is an anticonvulsant medication with a narrow therapeutic index.
    • Phenytoin intoxication can lead to a range of neurological and psychiatric symptoms.

    Observation:

    • This study investigated four patients with Phenytoin intoxication, comparing clinical-neurologic symptoms, Phenytoin blood levels, and electroencephalogram (EEG) changes.
    • Three patients presented with acute intoxication, one with subacute symptoms, including reversible cerebellar signs and organic brain syndrome. One patient also developed axonal polyneuropathy.
    • EEG abnormalities, characterized by nonspecific diffuse slowing with theta- and delta-activity, were observed in all patients during the acute phase.

    Findings:

    • Elevated Phenytoin blood levels correlated with toxic symptoms in three patients; one patient had levels within the therapeutic range but still exhibited symptoms.
    • EEG changes were reversible but often persisted longer than clinical symptoms and were sometimes detectable days before symptom onset.
    • In one case, generalized irregular spike-wave paroxysms on EEG were observed during Phenytoin withdrawal, suggesting an independent Phenytoin effect at high toxic doses or during withdrawal.

    Implications:

    • EEG monitoring can be a valuable diagnostic tool for Phenytoin intoxication, particularly in ambiguous cases, due to its accessibility compared to blood level estimation.
    • The findings highlight the potential for EEG to detect subclinical or prodromal changes associated with Phenytoin toxicity and withdrawal.
    • Understanding the spectrum of EEG findings in Phenytoin intoxication is crucial for accurate diagnosis and management of patients on this medication.

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