Phenytoin
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Phenytoin Orofacial dyskinesia in an elderly patient: case report An 80-year-old man developed orofacial dyskinesia during treatment with phenytoin following a seizure. The man, who had a history of hypertension and atrial fibrillation, was using a pacemaker and receiving acenocoumarol. He had no family history of epilepsy or movement disorders. Following diagnosis of a subdural haematoma and subsequent surgical evacuation, he suffered a generalised tonic-clonic seizure and received IV phenytoin (750mg bolus) followed by a maintenance dose of 300 mg/day taken orally. A few hours after starting treatment, he developed choreo-dystonic movements of his mouth and tongue, resulting in mild dysarthria; the remainder of the neurological examination was normal. His only other medication was paracetamol [acetaminophen] for pain. His phenytoin blood levels were within normal range. Due to the persistence of the orofacial dyskinesia and the absence of other likely causes, phenytoin was withdrawn 12 hours after starting treatment and was replaced with valproic acid. Following withdrawal of phenytoin, the man’s orofacial dyskinesia gradually reduced, and disappeared completely after 3 days. Author comment: We may conclude that phenytoininduced orofacial dyskinesia is an extremely rare side-effect which usually occurs with normal plasma levels. Garcia-Ramos R, et al. Phenytoin-induced acute orofacial dyskinesia. [Spanish]. Neurologia 28: 193-194, No. 3, Apr 2013. Available from: URL: http:// dx.doi.org/10.1016/j.nrl.2012.02.005 [Spanish; summarised from a translation] 803095324 Spain
0114-9954/13/1478-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 16 Nov 2013 No. 1478
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