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Incidence of seizures with phenytoin toxicity

From the Departments of Medicine, Psychiatry, and Neurology, Montefiore Medical Center (North Central Bronx Hospital), and the Albert Einstein College of Medicine, Bronx, NY.

Among 50 patients with phenytoin intoxication, 14 had seizures during the episode. Seizures in 9 of these 14 patients probably resulted from poor seizure control despite high phenytoin levels, but in 5 cases, attacks were attributed to phenytoin toxicity. The only factor that seemed to correlate with seizures was a serum phenytoin level over 30 µg/ml. No demographic, metabolic, neuropsychiatric, or therapeutic variables were predictive; nor were any other symptoms of toxicity particularly likely to be found in association with seizures. Seizures are an occasional manifestation of phenytoin toxicity, particularly when levels are high.

Address reprint requests to Dr. Masdeu, Department of Neurology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467.

Accepted for publication April 4, 1985.