Conjugate Lateral Gaze Nystagmus and Free Phenytoin Concentrations in Plasma: Lack of Correlation

Electrooculographic recordings during left and right conjugate lateral gaze fixation from 10o to 50o were made in 29 patients being treated with phenytoin. At the time of electrooculographic recordings, venous blood samples were drawn for analysis of total and free phenytoin plasma concentrations. Rhythmic horizontal nystagmus occurred in 7 patients, and only at extreme (40o, 50o) lateral gaze in 6 of these. Measurable free phenytoin levels in the 29 patients ranged from 0.2 to 3.2 jug/ml, and in the 7 patients with nystagmus were 0.6, 0.8, 1.0, 1.0, 1.7, 1.8, and 3.2g/ml. Neither the occurrence of nystagmus nor the degree of lateral gaze at onset could be correlated with free phenytoin concentrations in plasma.

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