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Choreo-athetosis induced by phenytoin in an epileptic child. A case report
Insights
Phenytoin intoxication in a child with epilepsy caused choreo-athetosis. Symptoms resolved after discontinuing the drug, despite delayed normalization of serum phenytoin levels.
Area of Science:
- Neurology
- Pediatrics
- Clinical Pharmacology
Background:
- Epilepsy management in children requires careful drug titration.
- Brain damage can alter drug metabolism and increase susceptibility to adverse effects.
- Phenytoin is a common antiepileptic drug with a narrow therapeutic index.
Observation:
- A 5-year-old child with epilepsy and brain damage presented with choreo-athetosis.
- The child was receiving phenytoin at a dosage of 75 mg three times daily.
- Serum phenytoin concentration was significantly elevated at 229 mmol/l, far exceeding the therapeutic range of 40-80 mmol/l.
Findings:
- Elevated serum phenytoin levels confirmed drug intoxication.
- Choreo-athetosis, a movement disorder, developed during phenytoin intoxication.
- The movement disorder resolved within 4 weeks of discontinuing phenytoin.
- Serum phenytoin levels normalized to the therapeutic range within 2 weeks of cessation.
Implications:
- This case highlights the risk of phenytoin-induced movement disorders, particularly choreo-athetosis, in pediatric patients.
- It underscores the importance of therapeutic drug monitoring for phenytoin to prevent toxicity.
- Clinicians should consider drug-induced movement disorders in patients with epilepsy experiencing new-onset involuntary movements, especially during periods of altered drug levels.
Abstract:
A 5-year-old child with epilepsy and underlying brain damage developed choreo-athetosis during intoxication with phenytoin. Drug intoxication was suggested by the dose the child was taking (75 mg 3 times a day) and confirmed by measuring the serum phenytoin concentration which was 229 mmol/l (therapeutic range 40-80 mmol/l). The choreoathetoid movements ceased 4 weeks after discontinuation of the drug, although the blood level returned to the therapeutic range after 2 weeks.