Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences.

Adverse drug reactions to commonly prescribed medications such as phenytoin, used for seizures, often go undetected due to various factors. This case report highlights a 52-year-old male diagnosed with late-onset epilepsy who was prescribed phenytoin. Despite the standard dosage, the patient experienced toxicity symptoms and a seizure, prompting admission for assessment. Laboratory tests and imaging were inconclusive, leading to a therapeutic drug monitoring (TDM) consultation, which revealed elevated phenytoin levels. Genetic testing for CYP2C9 polymorphisms was not feasible but noted as significant, especially in populations with higher prevalence. Phenytoin was tapered, leading to the patient's gradual recovery upon discontinuation and transition to valproate. The Naranjo scale predicted potential adverse drug responses (ADRs). This case underscores the significance of TDM, genetic considerations in drug metabolism, and the need to be vigilant in treating epilepsy to prevent such adverse events.

Unraveling the Interplay: Exploring the Links Between Gut Microbiota, Obesity, and Psychological Outcomes.

This narrative review delves into the complex and intricate mechanisms of the gut-brain axis. Gut microbiota has gained immense importance in the treatment of various diseases. The therapeutic potential of gut-microbial modulation is slowly coming to light. With good preclinical evidence, some human studies shed light on the translation potential of gut-microbial modulation. The concept of gut-microbial modulation has been studied for over a few decades. The relationship between gut microbiota and various homeostatic mechanisms is fascinating. Over the years, we have started understanding the immense role of gut microbiota in various homeostatic mechanisms. There are a good number of clinical studies that have shown the therapeutic potential of gut-microbial modulation in obesity and psychological diseases, especially depression and anxiety. The gut-microbial modulation can be achieved by dietary factors or supplementation. In this review, we explore the mechanisms by which prebiotics, probiotics, and synbiotics alter the gut-brain axis. The review limits its discussion to the most recent clinical studies that have shown promise as therapeutic strategies.