Herberg K P
South Med J. 1977 Jan;70(1):19-24. doi: 10.1097/00007611-197701000-00009.
Institutionalized epileptic patients on long-term anticonvulsant diphenylhydantoin (DPH) therapy were examined clinically. DPH plasma levels were unexpectedly high in 54% despite rather poor seizure control. No patient was free from side effects, which included gingival hypertrophy (90% of patients), increased alkaline phosphatase activity (55%), suggestion of a sensory peripheral neuropathy (34%), central nervous system (CNS) intoxication (22%), coarsened facial features (19%), tendency to bleed excessively (15%), hirsutism (12%), and mild megalocytic anemia (5%). CNS intoxication correlated with high plasma DPH levels, reports of deteriorating behavioral and motor performance, and the findings of nystagmus on vertical gaze or truncal ataxia, though not all patients with high plasma levels were clinically intoxicated. Alarming were the often disfiguring changes of gums and facial structures and the tendency to develop signs of vitamin D deficiency secondary to therapy. Hirsutism was rare in black patients. Plasma DPH level determinations are recommended as part of the management of mentally retarded epileptic patients but do not replace clinical acumen and skill.
对长期接受抗惊厥药物苯妥英钠（DPH）治疗的住院癫痫患者进行了临床检查。尽管癫痫控制效果相当差，但54%的患者DPH血浆水平意外升高。无一例患者无副作用，副作用包括牙龈增生（90%的患者）、碱性磷酸酶活性升高（55%）、提示感觉性周围神经病（34%）、中枢神经系统（CNS）中毒（22%）、面部特征变粗（19%）、出血倾向增加（15%）、多毛症（12%）和轻度巨细胞性贫血（5%）。CNS中毒与高血浆DPH水平、行为和运动表现恶化的报告以及垂直注视时眼球震颤或躯干共济失调的发现相关，尽管并非所有血浆水平高的患者临床上都有中毒表现。令人担忧的是牙龈和面部结构经常出现毁容性变化以及治疗继发维生素D缺乏迹象的倾向。多毛症在黑人患者中很少见。建议测定血浆DPH水平作为智力发育迟缓癫痫患者管理的一部分，但不能取代临床敏锐度和技能。
