Abstracts

It has now been approximately 2 years since the last new generation antiepileptic drug (AED) became available in the United States. Unfortunately, there are still patients not fully controlled. Due to this, we evaluated our practice to see how occasional patients on an older generation AED, ethotoin, had fared. We had at times utilized this drug in the late l980[apos]s and early l990[apos]s when newer drugs were not available. Ethotoin (Peganone) is 3-ethyl-5-phenylhydantoin. Introduced by Schwade and coworkers (1956), it appeared to be of some value in the treatment of temporal lobe as well as generalized tonic-clonic seizures and to be relatively free of the typical adverse effects of phenytoin.
The computer data bank from our epilepsy center revealed that 11 patients were still taking ethotoin. These patients were all on polytherapy, usually on 3 drugs, occasionally on 2 or 4 drugs. No patients were on ethotoin monotherapy.
The 11 patients were taking ethotoin ranging from 3 to 12 years (average 7.63 years). Seizure frequency was in most cases improved (however, this is a biased population in that, those still remaining on ethotoin would be those who had responded). Dosing was usually given on a qid basis, with dosages ranging from 2250 mg. to 6000 mg./day. Antiepileptic drug levels ranged from 21.3 ug/ml to 62.5 ug/ml. Even though clinical laboratories often report [quot]therapeutic levels[quot] as being 10-20 ug/ml, we have usually considered a [quot]therapeutic range[quot] to be 10-50 ug/ml. Patients tolerated levels up to 60 ug/ml with little or no side effects.
Ethotoin appears to be a viable alternative as adjunctive therapy for patients with partial and secondarily generalized seizures. The side effect profile is low, and the drug is well tolerated.