Adverse cognitive effects of phenytoin in severe brain injury: a case report.

BACKGROUND: The use of prophylactic anticonvulsants following brain injury is controversial. When used for this reason or for treatment of early seizures, anticonvulsants, particularly phenytoin, can cause severe cognitive side-effects. CASE REPORT: This study presents a case of a woman with a severe brain injury with severe cognitive impairment who improved dramatically following withdrawal of phenytoin. The literature regarding such cognitive side-effects is contradictory with no consistent indication of choice of anticonvulsants to use in this situation. CONCLUSION: As a result of the dramatic improvement in this case, one should now routinely withdraw or change phenytoin treatment in all brain injury patients with significant cognitive impairment.

Intrathecal phenol: an old treatment revisited.

PURPOSE: Severe bilateral leg spasticity can cause severe symptoms and reduced quality of life in affected individuals. It is often unresponsive to treatment. The objective of this study was to review the effectiveness of intrathecal phenol in the treatment of severe bilateral leg spasticity. METHOD: A retrospective case notes review of patients treated with intrathecal phenol by a rehabilitation service was performed. A simple rating scale based on comments in the case notes was used to identify changes in spasticity and treatment goals. RESULTS: Forty patients were identified as having been treated with intrathecal phenol over a 10-year period. All patients had improvements in their spasticity, 34 of which were rated as substantial or excellent. All patients (in whom the effect was documented), except one, had short-term improvement in the goals for treatment, 31 having substantial or excellent improvement. The effect was long lasting in many of the patients. Seven patients required repeat injections with similar outcomes. Seven patients experienced temporary side-effects. CONCLUSION: Intrathecal phenol is a useful alternative in treating selected patients with chronic severe bilateral leg spasticity that is unresponsive to other treatments.