I read with interest the valuable study by Ney et al1 on cerebellar atrophy in patients with complex partial seizures who were taking phenytoin. Sixteen of their 36 patients had no history of generalized tonicclonic seizures. Among these 16 patients, was there a higher incidence of atrophy than that expected in the control population? In a study using positron emission tomography with 18F-deoxyglucose, we found that cerebellar glucose metabolism was reduced in patients with complex partial seizures compared with control subjects.2 In our study, the effects of phenytoin were weak. I agree with Ney et al that phenytoin may have some influence on the development of cerebellar atrophy in patients with epilepsy, but I do not think that the effect is likely to be of clinical importance. Lindvall et al3 described a patient with acute subarachnoid hemorrhage who never had seizures, but who developed ataxia and
Theodore WH. Phenytoin and Cerebellar Atrophy. Arch Neurol. 1995;52(3):232. doi:10.1001/archneur.1995.00540270018008
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