We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Neurobehavioral Effects of Phenytoin and Carbamazepine in Patients Recovering From Brain Trauma: A Comparative Study

Kenneth R. Smith Jr, MD; Peggy M. Goulding, PhD; Diane Wilderman, RN; Peggy R. Goldfader, MA; Patricia Holterman-Hommes; Feifei Wei, PhD
Arch Neurol. 1994;51(7):653-660. doi:10.1001/archneur.1994.00540190029012.
Text Size: A A A
Published online


Objective:  To compare the effects of prophylactic anticonvulsant use of phenytoin and carbamazepine on the cognitive and emotional status of the patient after brain injury.

Design:  Double-blind, placebo-controlled study with assessments before and after withdrawal from drug treatment.

Setting:  Patients had been initially treated by neurosurgeons at a university hospital and were followed up during the study on an outpatient basis.

Patients:  Forty of 64 patients receiving phenytoin and 42 of 127 patients receiving carbamazepine from 6 to 44 months for seizure prophylaxis after brain injury met study criteria and were assigned to continue or discontinue treatment. Groups were balanced for age, sex, race, weight, intelligence, type of injury, duration of therapy, and drug plasma concentration at screening.

Intervention:  A battery of neuropsychological tests was administered twice during a 4-week baseline period, at the end of a 4- to 5-week period of continued drug treatment or placebo, and after 4 weeks of not receiving medication.

Main Outcome Measures:  Attention and concentration, psychomotor speed, memory, verbal fluency, and emotional state.

Results:  No significant differences were found in the performance of patients in medication and placebo groups for either drug at the end of the placebo phase. Patients in the combined groups showed significant improvement (P<.01) on several measures of motor and speeded performance following cessation of drug treatment. Multivariate analyses showed additional differences between phenytoin and carbamazepine and also suggested a significant practice effect on some measures used.

Conclusions:  Both phenytoin and carbamazepine seem to have negative effects on cognitive performance, particularly on tasks with significant motor and speed components. Practice effects were noted and may account for much of the improvement when patients stopped taking the drugs. Overall effects of the drugs were small and of limited clinical significance, but differences among subjects were noted that may affect selection of a particular drug for the individual patient.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.