The Role of Phenytoin in the Treatment of Localization Related Epilepsy: An International Internet-Based Survey of Neurologists and Epileptologists

Phenytoin (PHT) has been the most widely used medication to treat both partial and generalized seizures. However, over the past twenty years, a variety of new compounds have been released with comparable efficacy, fewer adverse effects, and more predictable pharmacokinetic properties. We surveyed neurologists and epileptologists to determine current practice patterns relating to the use of PHT using an online survey instrument. A total of 200 responses were obtained though response rates for each survey question varied. Of the respondents, 78.1% were epilepsy specialists; 60% were adult practitioners; and the remainder saw either, only children or both adults and children. For new onset partial seizures only 10 respondents said PHT would be their first or second choice, while 45% reported that they would not consider PHT. This study shows that in the era of newer medications, the role of PHT has been placed in the category of a reserve medication in intractable epilepsy. 1. Introduction Phenytoin (PHT) was first synthesized in 1908 at the University of Kiel in Germany. Anticonvulsant properties of this compound were first described by Merritt and Putnam in 1938, and PHT was brought to market by Parke Davis later that year [1–3]. Since its introduction as an anticonvulsant, PHT, marketed under the trade-name Dilantin, has been the predominant medication for the treatment of epilepsy for over 7 decades. The introduction of an IV formulation and later an IV pro-drug formulation (fosphenytoin) led to this medication being used as the first choice in the treatment of status epilepticus and acute repetitive seizures. However, with the introduction of numerous newer antiepileptic medications, with fewer adverse effects, better pharmacokinetic profiles, better patient tolerability, and proven efficacy, the role of phenytoin as a treatment of choice in epilepsy has become uncertain. The aim of the current study was to determine practice patterns among neurologists and epileptologists with regard to the use of PHT in the treatment of epilepsy. We also sought to understand the reasons why physicians prescribed (or did not prescribe) this important medication. We therefore surveyed neurologists and epileptologists to ascertain current practice regarding the use of PHT in treating persons with epilepsy. 2. Methods An online survey with eleven questions was created using the website http://www.surveymonkey.com/. A list of questions in the survey (and individual response rates for each question) is found in Table 1. Questions were designed to capture demographic and