Paradoxical seizure is an unusual reaction of seizure aggravation or change in its pattern due to antiepileptics. Decrease in seizure threshold with phenytoin is bound to occur with an increase in serum levels. We herein report a 51-year-old female, who was brought to the intensive care unit with complaints of episodic seizures and frothing. She is a known case of tonic–clonic epilepsy on oral phenytoin 100 mg for past 6 months. Rapid intravenous infusion of 700 mg phenytoin in 100 mL normal saline over a rate of 15 minutes was initiated on admission. This was followed by a sudden abnormality of her baseline blood parameters and an occurrence of paradoxical seizure. The dose of phenytoin was tapered which reversed her condition. The patient was followed up regularly and monitored for fluctuations in her hematological parameters. The mainstay treatment for phenytoin-induced paradoxical seizure and blood dyscrasias is to monitor the patient and dose titration. Dosing of phenytoin remains a challenge for all clinicians which increase the need for such reports.

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Introduction: Iron-deficiency anemia (IDA) during pregnancy affects the glial cells of the brain of mother, which results in altered neuronal myelination with dysregulation. Although several factors could lead to antenatal depression, IDA is an emerging etiology. The primary objective of this study is to determine the relationship between IDA and antenatal depression among pregnant women. Materials and Methods: This cross-sectional study was conducted at Government Head Quarters and Hospital, in Udhagamandalam. A total of 210 pregnant women in the second trimester were enrolled and categorized into iron-deficient anemia and noniron-deficient anemia groups based on their hematological results. The risk of depression was assessed using the validated Edinburgh Depression Scale (EDS). A Chi-square test for categorical variables and an independent t-test for continuous variables were used. A Pearson's correlation analysis was performed to check the association of EDS scores with participants' demographic characteristics and hematological parameters. Regression analysis was conducted to predict the outcome variable. Results: The distribution of depression was significantly varied between the groups. EDS score was significantly higher in the IDA group in comparison with the non-IDA group (12.78 ± 3.40 vs. 8.82 ± 3.12; P = 0.005; 95% confidence interval 2.94–4.87). The odds of developing antenatal depression are 12 times higher in the iron-deficient group, P < 0.001. Conclusions: Our findings suggest that IDA acts as an independent factor in influencing antenatal depression. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

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