Cerebellar Atrophy With Long-Term Phenytoin (Pht) Use: Case Report

Rissardo, Jamir Pitton; Caprara, Ana Letícia Fornari; Silveira, Juliana Oliveira Freitas

doi:10.37897/rjn.2017.3.8

Cited by 6 publications

(5 citation statements)

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“…In this context, abnormal involuntary movements related to PHT such as ataxia and tremor are frequently seen in clinical practice. They are mainly associated with cerebellar atrophy and dysfunction related to PHT[ 10 ]. In the past, the diagnosis of adverse drug reactions secondary to PHT only occurred with intoxication due to the unavailable measure of PHT serum concentrations.…”

Section: Introductionmentioning

confidence: 99%

Phenytoin-associated movement disorder

Rissardo

Caprara

2022

Tzu Chi Medical Journal

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Phenytoin (PHT) was first synthesized as a barbiturate derivative and was approved in 1953 by the Food and Drug Administration. This work aimed to review the pathophysiology, epidemiology, clinical presentation, and treatment of PHT-associated movement disorders (MDs). Studies were searched in relevant databases (ScienceDirect, Google Scholar, Excerpta Medica, Latin American and Caribbean Health Sciences Literature, Medline, and Scientific Electronic Library Online) and were selected by two reviewers irrespective of language between 1963 and 2021. Papers of PHT-induced ataxia alone or tremor were excluded. In total, 127 reports with 219 individuals who developed MDs associated with PHT were encountered. MDs found: 126 dyskinesias, 49 myoclonus, 19 dystonia, 14 parkinsonism, 6 tics, 3 stuttering, and 2 restless legs syndrome. The mean age was 35 years (standard deviation [SD]: 23.5) and the predominant sex was male (53.4%). The mean PHT dose when the MD took place was 370.4 mg (SD: 117.5). A serum PHT concentration was reported in 103 cases, ranging from 4 to 110 μg/mL (median: 27.7 μg/mL). No significant relationship was found between PHT dose and age or PHT level. The mean onset time of PHT-associated MD was 23.4 months (SD: 4.4). The mean recovery time after MD management was 3.7 weeks (SD: 1.1). Regarding management, the most common form was PHT withdrawal in 90.4%. 86.3% of the individuals recovered fully. PHT-induced MD was extensively reported in the literature. Only general terms were used in the majority of the reports. The mechanisms underlying the adverse events caused by PHT probably depend on the presence of predisposing factors.

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Section: Introductionmentioning

confidence: 99%

Phenytoin-associated movement disorder

Rissardo

Caprara

2022

Tzu Chi Medical Journal

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“…Akathisia is believed to be caused by alterations in dopamine signaling in the brain [45]. Some antiseizure medications can cause cerebellar atrophy [46] and contribute to the development of cerebellar signs and symptoms [47]. However, some new antiseizure medications [48] have yet to be associated with movement disorders [49].…”

Section: Anticonvulsantsmentioning

confidence: 99%

Understanding Drug-Induced Movement Disorders: Causes, Symptoms, and Treatment

R. Santos

2024

Preprint

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Drug-induced movement disorders (DIMDs) are a group of neurological conditions caused by the use of certain medications. These disorders can significantly impact a person's quality of life and are essential to recognize and manage. This article provides an overview of the causes, symptoms, and treatment of DIMDs. DIMDs can manifest in various forms, including parkinsonism, tardive dyskinesia, dystonia, and akathisia. They are most commonly associated with medications such as neuroleptics, antidepressants, antipsychotics, antiemetics, and anticonvulsants. Risk factors for developing DIMDs include age, genetics, duration of medication use, and dose of medication. Symptoms of DIMDs can range from mild to severe and may include tremors, rigidity, bradykinesia, and involuntary movements. These symptoms can significantly impact a person's ability to perform daily activities and lead to social isolation and decreased quality of life. DIMD diagnoses are based on clinical evaluation, including a thorough medical history and physical examination. Imaging studies such as MRI or CT scans may also be used to rule out other possible causes of symptoms. Treatment of DIMDs involves the withdrawal of the offending medication if possible. Pharmacological treatments such as anticholinergic drugs, benzodiazepines, and dopamine agonists may also be used to manage symptoms. Non-pharmacological treatments such as physical, occupational, and speech therapy can also be beneficial. DIMDs are necessary neurological conditions that can significantly impact a person's quality of life. Early recognition and management of these disorders are essential for optimizing outcomes. Further research is needed to understand the underlying mechanisms of DIMDs better and to develop more effective treatments.

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“…While phenytoin is generally effective in managing seizures, it has been associated with specific side effects, including movement disorders and other neuropsychiatric manifestations [44,45]. One movement disorder linked to phenytoin use is called cerebellar ataxia [46]. Phenytoin-induced cerebellar ataxia can result in unsteady gait, difficulty with balance, and coordination problems [47].…”

Section: Phenytoinmentioning

confidence: 99%

A Literature Review of Movement Disorder Associated with Medications and Systemic Diseases

Pitton Rissardo,

Fornari Caprara

2024

Preprint

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Movement disorders can be associated with various drugs and systemic diseases, posing diagnostic challenges for clinicians. This review explores the spectrum of movement disorders associated with pharmacological agents and medical conditions. Drug-induced movement disorders encompass a broad range of conditions resulting from exposure to medications that affect several neurotransmitters. Neuroleptic medications can lead to tardive dyskinesia, characterized by involuntary, repetitive movements. Antipsychotics and antiemetics, including metoclopramide, may induce acute dystonic reactions. Other drugs, such as dopamine receptor-blocking agents, can contribute to drug-induced parkinsonism. Beyond medications, movement disorders can also arise secondary to systemic diseases. Metabolic disorders like Wilson's disease, characterized by copper accumulation, may manifest as chorea or dystonia. Inflammatory conditions such as rheumatoid arthritis and systemic lupus erythematosus can result in secondary movement disorders due to autoimmune-mediated processes affecting the central nervous system. Movement disorders linked to drugs or systemic diseases often necessitate a thorough clinical evaluation, including detailed medication histories and comprehensive systemic assessments. Neuroimaging, laboratory investigations, and, in some cases, cerebrospinal fluid analyses and electrodiagnostic studies help in establishing accurate diagnoses. Management involves addressing the underlying cause, modifying medications, and employing symptomatic treatments.

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Cerebellar Atrophy With Long-Term Phenytoin (Pht) Use: Case Report

Cited by 6 publications

References 0 publications

Phenytoin-associated movement disorder

Phenytoin-associated movement disorder

Understanding Drug-Induced Movement Disorders: Causes, Symptoms, and Treatment

A Literature Review of Movement Disorder Associated with Medications and Systemic Diseases

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