1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-8-64 10.15844/pedneurbriefs-8-8-13 Seizure Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Cognitive Effects of PHT and CBZ After Brain Trauma http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 08 1994 01 06 2016 8 8 64 64 Copyright: © 1994 The Author(s) 1994 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Neurobehavioral effects of phenytoin and carbamazepine in patients recovering from brain trauma: A comparative study

The effects of prophylactic anticonvulsant use of phenytoin (PHT) and carbamazepine (CBZ) on the cognitive and emotional status of a total of 80 brain trauma patients are compared and reported from the Division of Neurosurgery and Department of Neurology, St Louis University School of Medicine and School of Public Health.

 Phenytoin Carbamazepine Cognitive Skills

The effects of prophylactic anticonvulsant use of phenytoin (PHT) and carbamazepine (CBZ) on the cognitive and emotional status of a total of 80 brain trauma patients are compared and reported from the Division of Neurosurgery and Department of Neurology, St Louis University School of Medicine and School of Public Health. The median ages of the two groups were 40 (PHT patients) and 36 (CBZ) years. Both phenytoin and carbamazepine had some negative effects on performance measured by neuropsychological tests. Effects generally were small in magnitude and were evident on tasks with motor and speed components. Earlier hypotheses that phenytoin had a more marked effect on higher-level cognitive skills than did carbamazepine were not confirmed. CBZ had a slightly greater negative effect than PHT on verbal fluency, verbal and visual memory, and complex attentional tasks. Patients receiving PHT were possibly more anxious compared to CBZ-treated patients. [1]

COMMENT. The neurobehavioral effects of phenytoin and carbamazepine were small and of limited functional significance. Most of the patients had no clinically detectable deficits while receiving either drug. Substantial variability was noted in drug serum concentrations at test sessions in individual patients, and between drug levels and test scores from subject to subject. Individual differences among patients and possible idiosyncratic responses to drugs are factors to be considered in the use or choice and evaluation of AEDs in brain trauma patients.

A previous randomized, double-blind study has shown that phenytoin prevents posttraumatic seizures only during the first week after severe head injury [2]. Some authorities have concluded that prophylactic drugs should be withheld, or administered only in a single loading dose, after severe head injury, minimizing the risk of idiosyncratic side-effects, especially exfoliative dermatitis. [3]

 Smith KR Jr Goulding PM Wilderman D Goldfader PR Holterman-Hommes P Wei F Neurobehavioral effects of phenytoin and carbamazepine in patients recovering from brain trauma: A comparative study Arch Neurol 1994 Jul 51 7 653 660 10.1001/archneur.1994.00540190029012 8018037 Temkin NR Dikmen SS Wilensky AJ Keihm J Chabal S Winn HR A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures N Engl J Med 1990 Aug 23 323 8 497 502 10.1056/NEJM199008233230801 2115976 Millichap JG Progress in Pediatric Neurology 1991 Chicago PNB Publishers 54 56