High-dose Monotherapy of Phenytoin for Intractable Temporal Lobe Epilepsy

Abstract

Fifty five patients with intractable temporal lobe epilepsy who had complex partial seizures more than once a month over one year despite anti-epileptic drug treatment were treated by monotherapy of phenytoin (PHT). The doses of PHT were increased principally until complex partial seizures were suppressed or toxic manifestations occurred. However, when the seizures are not controlled with over 30μg/ml of plasma concentration of PHT, the monotherapy was regarded as ineffective. As the result, 18 patients were controlled by PHT monotherapy for longer than 2 months at mean concentration of 20.8μg/ml. However, in about half of those patients the seizures were recurred after 6 months. On the other hand, the monotherapy was regarded as ineffective in 37 patients because of occurrence of side effects at mean concentration of 36.8μg/ml or unchanged seizure-frequency. For the ineffective cases with PHT monotherapy, the second drugs were added, and poly-therapy was effective only in one case. For the patients who had accompanied with secondarily generalized tonic-clonic seizures (sGTC) during monotherapy, the poly-therapy were effective for control of sGTC. It is concluded that the high-dose monotherapy of PHT is useful to treat the patients who had intractable temporal lobe epilepsy, and had not accompanied by sGTC.