First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate
Introduction: Phenytoin and sodium valproate are widely used antiepileptics with well documented side effects profile. However diffuse calvarial thickening and lingual dystonia with the use of phenytoin and sodium valproate respectively is extremely rare. This case underscores the importance of reco...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Mashhad University of Medical Sciences
2024-12-01
|
| Series: | Asia Pacific Journal of Medical Toxicology |
| Subjects: | |
| Online Access: | https://apjmt.mums.ac.ir/article_25498_339aefc21b6c8d2d717bec3442fb8853.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832575490216427520 |
|---|---|
| author | Sankavi Kaarthic Selvakumar CJ |
| author_facet | Sankavi Kaarthic Selvakumar CJ |
| author_sort | Sankavi Kaarthic |
| collection | DOAJ |
| description | Introduction: Phenytoin and sodium valproate are widely used antiepileptics with well documented side effects profile. However diffuse calvarial thickening and lingual dystonia with the use of phenytoin and sodium valproate respectively is extremely rare. This case underscores the importance of recognizing rare side effects in patients on long term anticonvulsant therapy.Case presentation: We present two cases of seizure disorder patients who were on first line antiepileptics phenytoin and sodium valproate developed uncommon side effects of diffuse calvarial thickening and lingual dystonia respectively during their follow up. CASE 1: 15 year old boy a case of refractory epilepsy with global developmental delay who was on multiple antiepileptics including phenytoin was admitted with breakthrough seizures. Patient had gum hypertrophy and serum phenytoin level was elevated and CT brain showed diffuse calvarial thickening, the offending drug was stopped. CASE 2: 45 year old female a case of idiopathic generalised epilepsy was started on sodium valproate for seizure control and she developed lingual dystonia during follow up. Having ruled out the secondary causes of dystonia the possible temporal association between the use of sodium valproate and lingual dystonia. Patient improved after stopping the use of sodium valproate.Discussion: This case report highlights two rare adverse effects associated with commonly used anticonvulsants emphasizing the need for heightened clinical vigilance.Early identification is essential for better clinical outcome.Conclusion: Long term use of phenytoin and sodium valproate can lead to rare but significant adverse effects such as calvarial thickening and lingual dystonia. |
| format | Article |
| id | doaj-art-f1ad8befd3aa4553969a0034f77fd30b |
| institution | Kabale University |
| issn | 2322-2611 2322-4320 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Mashhad University of Medical Sciences |
| record_format | Article |
| series | Asia Pacific Journal of Medical Toxicology |
| spelling | doaj-art-f1ad8befd3aa4553969a0034f77fd30b2025-02-01T06:56:21ZengMashhad University of Medical SciencesAsia Pacific Journal of Medical Toxicology2322-26112322-43202024-12-0113416416610.22038/apjmt.2025.83106.147725498First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproateSankavi Kaarthic0Selvakumar CJ1Department of Neurology, Coimbatore Medical College Hospital, Coimbatore, IndiaDepartment of Neurology, Coimbatore Medical College Hospital, Coimbatore, IndiaIntroduction: Phenytoin and sodium valproate are widely used antiepileptics with well documented side effects profile. However diffuse calvarial thickening and lingual dystonia with the use of phenytoin and sodium valproate respectively is extremely rare. This case underscores the importance of recognizing rare side effects in patients on long term anticonvulsant therapy.Case presentation: We present two cases of seizure disorder patients who were on first line antiepileptics phenytoin and sodium valproate developed uncommon side effects of diffuse calvarial thickening and lingual dystonia respectively during their follow up. CASE 1: 15 year old boy a case of refractory epilepsy with global developmental delay who was on multiple antiepileptics including phenytoin was admitted with breakthrough seizures. Patient had gum hypertrophy and serum phenytoin level was elevated and CT brain showed diffuse calvarial thickening, the offending drug was stopped. CASE 2: 45 year old female a case of idiopathic generalised epilepsy was started on sodium valproate for seizure control and she developed lingual dystonia during follow up. Having ruled out the secondary causes of dystonia the possible temporal association between the use of sodium valproate and lingual dystonia. Patient improved after stopping the use of sodium valproate.Discussion: This case report highlights two rare adverse effects associated with commonly used anticonvulsants emphasizing the need for heightened clinical vigilance.Early identification is essential for better clinical outcome.Conclusion: Long term use of phenytoin and sodium valproate can lead to rare but significant adverse effects such as calvarial thickening and lingual dystonia.https://apjmt.mums.ac.ir/article_25498_339aefc21b6c8d2d717bec3442fb8853.pdfadverse effectsphenytoinsodium valproatediffuse calvarial thickeninglingual dystonia |
| spellingShingle | Sankavi Kaarthic Selvakumar CJ First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate Asia Pacific Journal of Medical Toxicology adverse effects phenytoin sodium valproate diffuse calvarial thickening lingual dystonia |
| title | First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| title_full | First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| title_fullStr | First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| title_full_unstemmed | First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| title_short | First line antiepileptics and their hidden risks - a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| title_sort | first line antiepileptics and their hidden risks a unique case report on diffuse calvarial thickening and twisted tongue linked to the use of phenytoin and sodium valproate |
| topic | adverse effects phenytoin sodium valproate diffuse calvarial thickening lingual dystonia |
| url | https://apjmt.mums.ac.ir/article_25498_339aefc21b6c8d2d717bec3442fb8853.pdf |
| work_keys_str_mv | AT sankavikaarthic firstlineantiepilepticsandtheirhiddenrisksauniquecasereportondiffusecalvarialthickeningandtwistedtonguelinkedtotheuseofphenytoinandsodiumvalproate AT selvakumarcj firstlineantiepilepticsandtheirhiddenrisksauniquecasereportondiffusecalvarialthickeningandtwistedtonguelinkedtotheuseofphenytoinandsodiumvalproate |