Phenytoin toxicity: an easily missed cause of cerebellar syndrome.
We present a series of cases of phenytoin toxicity where the diagnosis was initially missed. These patients all suffered unnecessary morbidity or investigations. The side-effects and unusual pharmacokinetics of phenytoin are discussed, as well as the array of potential drug interactions. We remind clinicians that phenytoin toxicity can easily mimic a cerebellar lesion or alcohol intoxication, and suggest that in accordance with National Institute for Clinical Excellence (NICE) guidelines phenytoin should no longer be used as a first-line treatment for epilepsy.
Brostoff
J M
JM
Department of Elderly Care, Central Middlesex Hospital, London, UK. joshbrostoff@doctors.org.uk
Birns
J
J
McCrea
D
D
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D002526:Cerebellar Diseases / Q000139:chemically induced* / Q000175:diagnosis; D004827:Epilepsy / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics
D000927:Anticonvulsants; D010672:Phenytoin