Charcoal Hemoperfusion in the Therapy for Methsuximide and Phenytoin Overdose

Symptoms and course of intoxication with mesuximide — A case report

“…The molecular weight of MSM is 203.2 kD, and the protein binding of MSM is negligible, that of NDM is in the range of 45-60% [3]. Therefore, MSM as well as NDM serum concentrations can be reduced effectively by hemodialysis [4]. Mesuximide interacts with the following AEDs: the serum concentrations of phenobarbital and phenytoin are increased, and the serum concentrations of PRM, VPA, levetiracetam, topiramate, LTG, and oxcarbazepine are decreased in the presence of MSM [5].…”

“…To our knowledge, only a few reports of MSM intoxication have been published in the literature [4,8,9]. Karch described a two-peak course of MSM intoxication with initial lethargy, followed by some improvement and then delayed onset of profound coma in an 18-year-old patient [9].…”

“…In somnolent patients treated with MSM and NDM levels above the "therapeutic range" (10-30 mg/L [2]), a drug intoxication should be considered. In the absence of other explanations for the symptoms, an adequate treatment including hemodialysis should be initiated [4]. In terms of diagnostic confirmation ex juvantibus, the state of consciousness should improve during or shortly after dialysis.…”