The seizure medicine Dilantin was invented in 1908. It was discovered to be a chemical compound that could be used in conjunction with electroshock therapy as a prophylactic for convulsions, according to the Epilepsy Foundation.

By the 1940s, physicians and scientists were expanding its use to encompass treatment for seizure disorders and it was praised for starting a revolution of scientific innovation responsible for all the epilepsy drug choices available today.

Despite how old the seizure medicine Dilantin is in relation to these other epilepsy drug choices, it has an honorary place on the World Health Organization’s (WHO) List of Essential Medicines.

It is one of the cheapest as it is available generically as phenytoin in the developing world for a wholesale cost of $.003 and $.15 per individual dose. This translates to about a dollar a day for a patient taking the ‘grandfather’ seizure medicine Dilantin in the U.S.

The medicine Dilantin is rarely the first choice for most patients among U.S. doctors. It is, however, used in recalcitrant cases where other drugs have proven ineffective or capable of producing side effects too difficult or consequential.

It is also routinely stocked in hospital emergency rooms and used with status epilepticus—a serious, life-threatening medical situation in which the body is in a continual state of seizure activity. It may also be used in other circumstances in E.R.s and urgent care facilities.

The Connection Between the Seizure Medicine Dilantin and Brain Atrophy

Studies in recent years have produced data linking high-dosage level or long-term use of the seizure drug Dilantin with shrinkage of the cerebellum. The cerebellum is a bilateral lobe which sits behind the brain stem and underneath the cerebrum.

The cerebellum has a specific function as the supreme coordinator of gross and fine motor muscular actions. Its atrophy can be noted in a variety of ways from a type of rapid eye movement known as nystagmus to difficulty with the tongue lending to slurred speech to a characteristically side-to-side torso swing gait that is tentative. To the untrained eye, a sufferer may appear as if they are intoxicated or on some sort of drug.

In the 1990s, a study was completed which compared the cerebellum size of patients before and afterwards. The study was double-blinded—which meant the researchers didn’t know what patient was being given which medicine. Half of the enrollees were given Dilantin and half were given an alternate seizure medication. A magnetic resonance imaging (MRI) scan was used to compare lobe dimensions.

Of importance in reviewing this landmark study is the knowledge that diagnosis of a seizure disorder itself can affect cerebellum size. Because of this, all participants had similar diagnoses. The post-study images showed differences in patients treated with Dilantin—the lobe was much smaller overall.

What remains obscure is whether or not some of the lost connections can be regained after removing this drug treatment regimen. Remarkable improvement has been noted in some cases and not in others.