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• W2057207754 abstract "Summary: We examined the incompletely defined con-vulsant action of phenytoin (PHT) at toxic concentrations in humans. A retrospective chart review (1979–1985) yielded 96 cases (90 patients), meeting both clinical and laboratory criteria for PHT intoxication. Seven patients, all with epilepsy, had one or more seizures while toxic. However, in only two patients (2.1%) with serum concentrations of 93.2 and 69.7 u, g/ml was a causal relationship deemed highly probable. Seizures did not occur in most toxic epileptic patients with total serum PHT con-centrations as high as 85.1 jig/ml or in any of the none-pileptic patients with concentrations as high as 64.2 |Lg/ml. The lack of convulsant action of PHT in these patients suggests that seizure risk may be multifactorial and also that PHT is a weak convulsant. We conclude that PHT at very high concentrations can rarely exacerbate seizures or even precipitate generalized status in some epileptic patients, a paradoxical effect. RÉSUMÉ Les auteurs ont étudil I'activité convulsivante, encore mé-connue, de la phénytoïne à concentration toxique. examen rétrospectif des dossiers de 1979 à 1985 a permis de retrouver % observations (chez 90 patients) dans lesquelles étaient réunis les critères cliniques et biologiques de intoxication par phénytoïne. Sept sujets, tous épileptiques, ont présenté au moins une crise pendant la phase intoxication. 11 n'y avait cependant que 2 patients (2.1%) pour lesquels, avec des taux sanguins de 93.2 et de 69.7 (μg/ml, une relation causale a été jugée tres probable. ll n'y a pas eu de crises chez la majorité des épileptiques intox-iqués, malgré des taux sanguins atteignant 85.1 μg/ml. ni chez aucun des patients nonépileptiques, malgré des taux sanguins atteignant 64.2 μg/ml. absence activité convulsivante de la phénytoïne chez ces patients suggère que le risque de crise est multifactoriel et que la phénytoïne est un convulsivant faible. Les auteurs concluent que de très hauts taux sanguins de phé-nytoïne peuvent rarement, chez certains patients, exacerber les crises ou même provoquer un état de mal généralisé, ce qui constitue un effet paradoxal. RESUMEN Hemos examinado la acción convulsiva, incompletamente definida, de la actión de la fenitoina en concentraciones tóxicas en humanos. Una revisión retrospectiva (1979/85) ha revelado 96 casos (90 pacientes) que presentaban criterios clínicos y de laboratorio de intoxicación fenitoínica. Siete enfermos, todos ep-ilépticos, tuvieron uno o más ataques durante el periodo de toxicidad. Sin embargo, en sólo 2 enfermos (2.1%) con concentraciones séricas de 93.2 μg/ml y 69.7 μg/ml se encontró una relación causal estimada como altamente probable. Los ataques no se presentaron en la mayoría de los enfermos epilépticos tóxicos con concentraciones totales séricas de fenitoina tan ele-vadas como 85.1 μg/ml ni en ninguno de los enfermos no epilép-ticos con concentraciones tan altas como 64.2 μg/ml. La falta de acción convulsiveógena de la fenitoina en estos pacientes sugiere que el riesgo de ataques puede ser multifactorial y también que la fenitoina es un débil factor convulsiveógeno. Concluimos que la fenitoina en concentraciones muy elevadas puede, raramente, exacerbar los ataques o, incluso, precipitar un status en algunos enfermos epilépticos, lo que constituye un efecto paradógico." @default.
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• W2057207754 date "1989-04-01" @default.
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• W2057207754 title "Phenytoin-Induced Seizures: A Paradoxical Effect at Toxic Concentrations in Epileptic Patients" @default.
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• W2057207754 doi "https://doi.org/10.1111/j.1528-1157.1989.tb05459.x" @default.
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