Phenytoin-related ataxia in patients with epilepsy: clinical and radiological characteristics
| Autor: | Daniel Aeschlimann, Pascale Aeschlimann, Priya D. Shanmugarajah, Markus Reuber, Nigel Hoggard, Stephen Howell, Richard A. Grünewald, Gary Dennis, Marios Hadjivassiliou |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Phenytoin Cerebellum Pediatrics medicine.medical_specialty Ataxia medicine.medical_treatment Neuroimaging Neurological examination Antibodies Gliadin 03 medical and health sciences Epilepsy Folic Acid 0302 clinical medicine GTP-Binding Proteins medicine Cerebellar Degeneration Humans Protein Glutamine gamma Glutamyltransferase 2 Longitudinal Studies 030212 general & internal medicine Neurologic Examination Transglutaminases medicine.diagnostic_test Cerebellar ataxia business.industry Brain General Medicine medicine.disease medicine.anatomical_structure Anticonvulsant Neurology Sensation Disorders Anticonvulsants Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| ISSN: | 1059-1311 |
| Popis: | Purpose\ud \ud \ud Phenytoin is an effective anticonvulsant for focal epilepsy. Its use can be associated with long-term adverse effects including cerebellar ataxia. Whilst phenytoin is toxic to Purkinje cells in vitro; the clinical and radiological phenotype and mechanism of cerebellar degeneration in vivo remain unclear. We describe the prevalence, clinical and radiological characteristics of phenytoin-related ataxia.\ud \ud \ud \ud Methods\ud \ud \ud Patients with epilepsy receiving treatment with phenytoin were recruited from the Epilepsy clinics at Royal Hallamshire Hospital, Sheffield, UK. Neurological examination was performed on all patients after recruitment. Patients were categorised into those with and without ataxia. We determined the severity of ataxia clinically (SARA score) and the pattern of cerebellar involvement by neuroimaging (MRI volumetry and MR spectroscopy).\ud \ud \ud \ud Results\ud \ud \ud Forty-seven patients were recruited. Median duration of epilepsy was 24 years, median duration of phenytoin treatment was 15 years and current median phenytoin daily dose was 325 mg. Fifty-five percent of patients complained of poor balance. Clinical evidence of ataxia was seen in 40% patients. Gait, stance and heel-shin slide were the predominant features of cerebellar dysfunction. MRI demonstrated structural, volumetric and functional deficits of the cerebellum. Only one patient with ataxia had phenytoin levels above the normal range.\ud \ud \ud \ud Conclusions\ud \ud \ud Cerebellar ataxia is present in 40% of patients with epilepsy and chronic exposure to phenytoin. Patients on long-term phenytoin have reduced cerebellar volume even if they have no clinical evidence of ataxia. Evidence of structural deficits on imaging suggests a predilection for vermian involvement. |
| Databáze: | OpenAIRE |
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