CARBAMAZEPINE AND PHENYTOIN IN EPILEPSIES REFRACTORY TO BARBITURATES - EFFICACY, TOXICITY AND MENTAL FUNCTION

A group of 51 patients with chronic cryptogenic or symptomatic localiz ed epilepsy refractory lo therapy with barbiturates underwent progress ive substitution with phenytoin or carbamazepine, in standardized and randomized fashion. After drug changes were completed two thirds of th e patients remained seizure free during a period of 6 months. A cleare r effect of phenytoin and carbamazepine was seen on secondary generali zed than on partial seizures. The frequency of severe side effects dec reased after the change to phenytoin and carbamazepine. The group on c arbamazepine improved in immediate and late recall, and in immediate a nd late recognition of pictures. The group on phenytoin improved signi ficantly in the Stroop test. Patients changed to phenytoin, but not th ose changed to carbamazepine, became significantly more aggressive, an xious and depressive than when on phenobarbital, as measured by subjec tive scales. The results indicate that patients should not be consider ed refractory to antiepileptic drug therapy while on barbiturates. Cog nitive dysfunction and mood changes observed in epilepsy may be tempor ary and dependent on the presence of seizures and/or on use of barbitu rates.