ACUTE AND CHRONIC TOXICITY OF ANTIEPILEPTIC MEDICATIONS - A SELECTIVEREVIEW

Acute and chronic toxicity complicates all antiepileptic medications ( AED) and is idiosyncratic. Acute toxicity can be categorized into 1) a cute brain dysfunction or 2) acute organ dysfunction when AED's are st arted. Despite promising in vitro lymphocyte testing, anticipation of acute reactions cannot be offered. Furthermore, screening for AED toxi city by routine blood and urine tests in asymptomatic patients is of d oubtful value and should be abandoned. Patients should be informed of possible reactions and immediately report early symptoms. Treatment fo r acute reactions is largely unstudied. It is unclear how to reintrodu ce AED's following acute reactions. Often patients are sensitive to dr ugs with a similar chemical structure. The ''desensitization'' protoco l of Purvis may be of merit. Three major chronic toxicities of AED's h ave been noted - soft tissue and gum hypertrophy, progressive ataxia, and peripheral neuropathy. New AED's require careful post-marketing su rveillance since long term toxicity data are not yet available.