Monotherapy and combination therapy with phenytoin and carbamazepine. Smooth-persuit eye movement and serum level of antiepileptics.:Smooth-Persuit Eye Movement and Serum Level of Antiepileptics

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Adverse effect of phenytoin (PHT) and carbamazepine (CBZ), alone and in combination, to the patients with temporal lobe epilepsy, was discussed. Impairment of smooth-persuit eye movement (SPEM) was used as an indicator for the adverse effect of the antiepileptic drugs. SPEM was examined simultaneousl with measurement of serum concentration of PHT or CBZ at more than three different points in each patient. The mean correlation rate between serum level and threshold of SPEM was -0.94 in six cases with PHT and -0.55 in four cases with CBZ monotherapy. Despite inter-individual variation, the positive inverse-correlation between SPEM threshold and serum level of the antiepileptic drugs was found intra-individually, especially in patients with PHT monotherapy. The process of impairment of SPEM was nearly parallel with increase of serum level. In combination therapy, a higher degree of impairment of SPEM was observed than in monotherapy with each of them. In one case, whose SPEM was measured at four different points during PHT alone, four pointts during CBZ alone, and two points during PHT and CBZ in combination, supra-additive impairment of SPEM was observed in combination therapy.
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