Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085584 (encephalopathy)
 18,178 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Protein binding of phenytoin was assesed in one patient with dialysis encephalopathy before and after haemodialysis. Phenytoin concentrations were measured by radioimmunoassay and continuous ultrafiltration was used to assess phenytoin binding. At a serum concentration of 60 micromol.1-1 the percentage of phenytoin bound to serum albumin was considerably lower in the patient serum (79.95% predialysis; 92.09% postdialysis) than that in three normal sera (97.90 +/- 0.17%). Analysis of Scatchard plots indicated two classes of binding sites. In class I both the affinity and capacity for binding phenytoin were reduced in the pre and post-dialysis serum, whereas in class II the capacity of the uraemic serum was increased although the intrinsic association constant was greatly reduced. It was concluded that in vivo haemodialysis is associated with large fluctuations in the protein binding of phenytoin, in which the concentration of endogenous dialysible metabolites are strongly implicated.
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PMID:Alterations of phenytoin protein binding with in vivo haemodialysis in dialysis encephalopathy. 42 30

A case of phenytoin (DPH) encephalopathy with increasing seizures and EEG and mental changes is described. Despite adequate oral dosage of DPH (5 mg/kg/daily) the plasma level was very low (2.8 microgramg/ml). The encephalopathy was probably an idiosyncratic and not toxic or allergic reaction. In fact the concentration of free DPH was normal, the patient presented a retarded morbilliform rash during DPH treatment, the protidogram was normal, and an intradermic DPH injection had no local effect. The authors conclude that in a patient starting DPH treatment an unexpected increase in seizures, with EEG and mental changes occurring simultaneously, should alert the physician to the possible need for eliminating DPH from the therapeutic regimen, even if plasma concentrations are low.
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PMID:Phenytoin encephalopathy as probable idiosyncratic reaction: case report. 89 94

Similar movement disorders developed in two 8-year-old retarded children while they were receiving phenytoin. Seizures subsequent to a diphtheria-pertussis-tetanus immunization had developed in each child at 1 to 2 months of age. A static encephalopathy ensued, characterized by mental retardation, ataxia, spasticity, and a mixed seizure disorder. Intermittent dystonia and choreoathetosis developed insidiously while serum phenytoin concentrations were in the therapeutic range. Sustained dystonia and choreoatheosis developed 2 hours after an oral provocation with phenytoin. The baseline abnormalities on the electroencephalogram remained unchanged during the choreoathetosis. Recognizable metabolic abnormalities known to be associated with similar movement disorders were excluded. It was concluded from these studies that the movement disorder is secondary to phenytoin and can occur at therapeutic serum concentrations. Phenytoin is a central anticholinergic agent and a central stimulant of serotonin, and may induce movement disorders as a result of altering these neurotransmitters in the brain. The variable expression of these movement disorders may relate to the nature of the preexisting striatal insult.
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PMID:Phenytoin-induced dystonia and choreoathetosis in two retarded epileptic children. 94 1

A total systems approach was used to study the structural and functional properties of red blood cells in 100 patients suffering from atherosclerotic circulatory encephalopathy, stages I-III: aggregation, deformability, superficial cytoarchitectonics, the content of ATP and 2,3 DPH, transport of univalent cations, and the cholesterol/phospholipid index of membranes. It has been demonstrated that as the atherosclerotic process progresses, the membrane rigidity increases as a result of excessive concentration of cholesterol in the cell, aggregation is enhanced, transport of ions and substances gets disturbed, the processes of glycolysis and synthesis of macroergs get inhibited. All this brings about the derangement of transport function of the cells because of disturbance of the properties of moving in the system of microcirculation.
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PMID:[Structural and functional properties of erythrocytes in patients with arteriosclerotic circulatory encephalopathy]. 166 83

In a review of more than 200 studies over the last three decades, the manifold psychic effects of anticonvulsives on healthy persons, on patients with and without epilepsy, on patients with mental disorders with or without cerebral damages are analysed and summarized. The following results are mainly shown: 1. Carbamazepine: a positive effect on "expansive" behaviour and mood can be observed in about 50-60% of the patients. The cognitive and psychomotor performance is almost unchanged. 2. Valproinate: Negative psychic effects can rarely be seen for a longer time (exception: reversible encephalopathy). The behaviour can similarly be influenced as with carbamazepine. 3. Phenytoin: Cognitive and psychomotor performance is negatively influenced. The effects on behaviour are contradictory. 4. Phenobarbitone and Primidone: Diverse negative effects on performance and behaviour, especially as "expansive" disorders in children and adolescents, seemed to be proven. 5. Ethosuximide: Beside the drug specific provocation of psychotic disorders, both, positive and negative effects on behaviour and cognitive functions are discussed. 6. The psychic effects of other anticonvulsives such as Benzodiazepines, Sulthiame and Pheneturide are shortly summarized. 7. Polytherapy: Negative influences on psychic functions are significant. Finally the results are discussed concerning their clinical relevance.
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PMID:[Anticonvulsants and their psychological effects--a review]. 240 25

17 (33%) of 52 patients who underwent 56 consecutive orthotopic liver transplants had serious neurological complications postoperatively. The commonest complication was fits, which occurred in 13 (25%) patients. 50% of patients had their onset of fits within the first week. In 3 patients the fits were associated with postoperative metabolic encephalopathy and fatal progressive neurological deterioration. In some patients the evidence implicating cyclosporin in the development of fits is strong. In others factors such as electrolyte disturbances, steroid treatment for graft rejection, and cerebral infarction may have contributed to the development of the fits. Phenytoin controlled the fits in 10 out of 13 patients. Other neurological complications included 1 case of central pontine myelinolysis, 1 of cerebral abscess, and 4 of non-encephalopathic psychosis.
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PMID:Neurological complications following liver transplantation. 288 42

A 81 year-old female, weighing 56 kgs, had taken carbamazepine (10.2 mg/kg/day) for simple partial motor seizures of recent onset during 15 days. EEG recording showed slow waves on the left hemisphere. CT was normal. The seizures were controlled for a few days and then reappeared beginning as simple partial seizures and progressing to impairment of consciousness. The patient became confused. On admission she was severely confused. Neurological examination was otherwise normal. Plasma sodium level was 134 meq/l and CBZ plasma level was 4.3 micrograms/ml. EEG showed high voltage bilateral delta waves and a left focus. The drug was withdrawn with relief of clinical symptoms and to a lesser extent, of EEG abnormalities. Phenytoin encephalopathy is a well known pathological entity but to our knowledge there has been no report of carbamazepine encephalopathy with neither excessive plasma level of the drug nor water intoxication. An idiosyncratic reaction is considered likely.
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PMID:[Subacute encephalopathy. Idiosyncratic reaction to carbamazepine?]. 361 67

A case of phenytoin-induced hepatitis with mononucleosis is reported, and syndromes associated with phenytoin hypersensitivity reactions are discussed. A 23-year-old black woman with a two-month history of seizure disorder was admitted to a hospital with nausea, vomiting, fever, lymphadenopathy, diffuse maculopapular rash, left-upper-quadrant tenderness, and hepatomegaly. She was receiving phenytoin sodium 300 mg/day; carbamazepine 200 mg four times daily had been discontinued four days before admission because of leukopenia. Phenytoin was discontinued after admission; however, phenytoin 1 g i.v. was given for a tonic-clonic seizure two days after admission, after which swelling of the face and legs and pruritus developed. Over the next few days, signs and symptoms of hepatotoxicity progressed, and she became comatose. Seizures were treated with diazepam. She began to recover after 10 days of supportive therapy and was discharged several weeks later on primidone therapy. Serious phenytoin hypersensitivity reactions may appear as dermatologic, lymphoid, or hepatic syndromes. Fever, rash, and lymphadenopathy often accompany hepatic injury. Encephalopathy and death may occur. Proposed mechanisms for phenytoin hypersensitivity include antigen-antibody reactions, alteration of lymphocyte function, and an enzyme abnormality causing the production of toxic metabolites. Treatment is supportive; phenobarbital and carbamazepine may be used with caution as alternate anticonvulsant therapy. The possibility of phenytoin hypersensitivity reactions should be considered when patients receiving phenytoin have unusual symptoms, particularly fever, rash, and lymphadenopathy.
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PMID:Phenytoin-induced hypersensitivity reactions. 367 71

We report a patient with a severe hypoxic encephalopathy. The electroencephalogram revealed both an "alpha-coma" pattern and generalized intermittent runs of 11/2-21/2 spikewave activity. The paroxysmal activity was suppressed by Dilantin leaving the underlying "alpha rhythm" intact. This association has only been touched upon in the past.
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PMID:"Alpha-coma" in association with generalization paroxysmal (spike-wave) activity: a case report. 723 51

Subacute encephalopathy developed in four patients within one to two months after undergoing high-dose chemotherapy and bone marrow transplantation or peripheral blood progenitor (stem) cell transplantation for breast cancer, acute myeloid leukemia, and non-Hodgkin's lymphoma. None of the patients had previously known neurologic disorders, central nervous tumor or infection. Two patients presented with generalized tonic, clonic seizures, and two with confusion and lethargy. In all patients lumbar puncture and CT scans of the brain were normal, while magnetic resonance imaging (MRI) demonstrated multifocal predominantly white matter lesions. Phenytoin therapy was given to the two patients with seizures and all four patients improved without specific therapeutic intervention. Repeat MRIs became normal within three months. We report a delayed and transient encephalopathy which appears to be a unique complication of high-dose cytotoxic chemotherapy. The corresponding brain lesions may not be appreciated on CT scans, suggesting an expanded role for MRI studies in patients who develop neurologic findings while undergoing high-dose cytotoxic therapy.
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PMID:Delayed, transient encephalopathy after marrow transplantation: case reports and MRI findings in four patients. 884 58


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