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Akinetic mutism due to diphenylhydantoin toxicity
S Tütüncüoğlu1, M Kantar, H Tekgül
1Department of Pediatrics, Ege University Faculty of Medicine, Izmir.
The Turkish Journal of Pediatrics
|July 1, 1997
Summary
Akinetic mutism (AM), a rare unconscious state, was observed in a 12-year-old epileptic patient due to diphenylhydantoin (DPH) toxicity. Treatment with carbamazepine resolved the AM symptoms.
Area of Science:
- Neurology
- Toxicology
Background:
- Akinetic mutism (AM) is a rare neurological condition characterized by apparent wakefulness without mental activity, speech, or response to stimuli.
- Causes of AM include tumors, vascular events, drug toxicity, and radiotherapy.
Observation:
- A 12-year-old epileptic patient presented with AM and elevated serum diphenylhydantoin (DPH) levels (>40 µg/ml).
- The patient exhibited unresponsiveness, mutism, and lack of movement despite stimuli.
- MRI revealed mild cerebellar atrophy; other AM causes were ruled out.
Findings:
- The patient's AM was attributed to DPH toxicity.
- Discontinuation of DPH and initiation of carbamazepine led to the resolution of AM symptoms within two months.
- The patient remained symptom-free at a two-year follow-up.
Implications:
- This case highlights diphenylhydantoin toxicity as a potential cause of akinetic mutism.
- It underscores the importance of monitoring drug levels in patients presenting with unexplained neurological symptoms.
- This adverse effect of DPH has not been previously reported, suggesting a unique patient sensitivity or interaction.