SciELO - Scientific Electronic Library Online

 
vol.52 issue4Multiple sclerosis and positive lyme serologyCerebellar syndrome by amiodarone author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.4 São Paulo Dec. 1994

http://dx.doi.org/10.1590/S0004-282X1994000400020 

Ataxia cerebelosa persistente despues de la administracion toxica de difenilhidantoina

 

Persistent cerebellar ataxia due to acute diphenylhydantoin intoxication

 

 

Andrés M. Villa; Roberto E.P. Sica

Division Neurologia, Hopital Ramos Mejia, Buenos Aires

 

 


RESUMEN

La intoxicacion cronica con difenilhidantoina (DFH) es bien conocida como causa de ataxia irreversible en pacientes epilépticos debida a atrofia cerebelosa con perdida de células de Purkinje. No es asi con la intoxicación aguda, puesto que sus signos y síntomas son reversibles. Presentamos un paciente con convulsiones parciales complejas, secundarias a un quiste temporal, que habia sido tratado irregularmente con DFH durante dos años con dosis variables que oscilaban en los 100 mg/dia. Dada la refractariedad de su cuadro convulsivo en una entrevista previa a su ingreso se le indico un aumento brusco de la dosis del fármaco que alcanzo a los 400 mg/dia. Ello ocasiono un sindrome pancerebeloso severo que motivo su internación. Posteriormente a la suspension de la DFH y la exeresis del quiste temporal mejoro su cuadro convulsivo, aunque quedo con ataxia de miembros inferiores y asinergia de tronco, cuadro con el que fue dado de alta. Un año despues, el paciente se encontraba libre de convulsiones, pero su sindrome cerebeloso no se habia modificado. El estudio por imágenes no evidencio atrofia cerebelosa.

Palabras-llave: difenilhidantoina, intoxicación aguda, sindrome cerebeloso, epilepsia.


SUMMARY

Diphenylhydantoin (DFH) is known to yield cerebellar ataxia in chronically treated epileptic patient due to cerebellar atrophy with loss of Purkinje cells. Little attention has been paid in the literature to the acute DFH intoxication bearing cerebellar symptoms. We report a patient afflicted with complex partial seizures due to a left temporal cyst, who has been treated during the last two years with DFH 100 mg/day.Due to the refractory characteristics of his seizures he was put on DFH 400 mg daily, and developed a pancerebellar syndrome. After surgical removal of the cyst his seizures entirely faded away and his cerebellar signs improved. Nevertheless his neurological examination still showed trunkal and lower limbs ataxia. After one year of follow up his neurological picture did not change, while he was seizures free. TC and MRI did not show cerebellar atrophy.

Key words: diphenylhydantoin, acute intoxication, cerebellar syndrome, epilepsy.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS

1. Dam M. Number of Purkinje cells in patients with grand mal epilepsy treated with diphenylhydantoin. Epilepsia 1970, 11: 199-205.         [ Links ]

2. Dam M. Number of Purkinje's cells after diphenylhydantoin intoxication in pigs. Arch Neurol 1970, 22:64-67.         [ Links ]

3. Haberlond. C. Cerebellar degeneration with clinical manifestation in chronic epileptic patients. Psychiatr Clin 1962, 143: 29-44.         [ Links ]

4. Home PLD. Long term anticonvulsant therapy and cerebellar atrophy. J Ir Med Assoc 1973, 66: 147-152.         [ Links ]

5. Imamura T., Ejima A. Cerebellar atrophy and persistent cerebellar ataxia after acute intoxication of phenytoin. No To Shinkei 1992, 44: 149-153.         [ Links ]

6. Kokenye R. Neurological sequelae following Dilantin overdose in a patient and in experimental animals. Neurology 1965, 15: 823-829.         [ Links ]

7. Minoque SJ. Cerebellar degeneration with epilepsy. Med J Aust 1945, 1: 430-433.         [ Links ]

8. Nityar R. Ghatak R. Cerebellar degeneration following long-term phenytoin teraphy. Neurology 1976, 26: 818-820.         [ Links ]

9. Porter RJ, Theodore W.H. Neurologic Clinic. Phidelphia: Saunders, 1986, Vol 4, No 3, p. 591-597.         [ Links ]

10. Selhorst JB, Kaukman B. Diphenylhydantoin induced cerebellar degeneration. Arch Neurol 1972, 22: 435-455.         [ Links ]

11. Utterback RA. Parenchymatous cerebellar degeneration complicating diphenylhydantoin (Dilontin) therapy. Arch Neurol 1958, 80: 180-181.         [ Links ]

 

 

Aceite: 7-junho-1994.

 

 

Dr. Andres Maria Villa - Division Neurologia, Hospital Ramos Mejia - Urquiza 609 - 1221 Buenos Aires -Argentina.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License