McLain L W, Martin J T, Allen J H
Ann Neurol. 1980 Jan;7(1):18-23. doi: 10.1002/ana.410070106.
Five patients developed cerebellar degeneration while being treated with phenytoin. All had high plasma levels of the drug, and none was having seizures of a type that could have caused systemic hypoxia at the time the cerebellar syndrome appeared. Cerebellar degeneration was confirmed by the finding of atrophy on CT scan and by persistence of cerebellar signs when plasma phenytoin levels were decreased. We suggest that chronic phenytoin therapy can cause cerebellar degeneration. The question of whether phenytoin or the cumulative effect of hypoxia from repeated convulsions causes cerebellar degeneration should not be posed as one of exclusive alternatives, since hypoxia is a well-known cause of cerebellar atrophy. Instead, the question should be whether or not phenytoin can also be responsible. The cases reported here suggest that it can.
五名患者在接受苯妥英治疗时出现小脑变性。所有患者的血浆药物水平都很高，并且在小脑综合征出现时，没有一人发生过可能导致全身缺氧的癫痫发作类型。通过CT扫描发现萎缩以及当血浆苯妥英水平降低时小脑体征持续存在，证实了小脑变性。我们认为慢性苯妥英治疗可导致小脑变性。不应将苯妥英还是反复惊厥引起的缺氧累积效应导致小脑变性的问题作为排他性的选择之一提出，因为缺氧是小脑萎缩的一个众所周知的原因。相反，问题应该是苯妥英是否也有责任。此处报告的病例表明它可能有责任。
