The Modern Treatment of Epilepsy: A Critical Survey, with Special Reference to Sodium Diphenyl Hydantoinate and a Comparison of its Effects with Those of other Anticonvulsants
The above investigation of 36 patients suffering from chronic psychotic epilepsy on epanutin treatment, of whom 20 remained on treatment for more than one year, emphasizes the following points: 

1. Toxic symptoms of the nervous system were frequent and usually severe. Of particularly ominous nature seemed psychosomatic delusions, revival of such psychotic symptoms as severe depression, etc. Toxic symptoms were not correlated with age and appeared more a matter of individual idiosyncrasy of the nervous system than other constitutional factors. No toxic symptoms of severity occurred in any other system.

2. The reduction in fits in tile 20 patients treated for a year was absolute in one case, over 75 per cent. in six cases; between 50 and 75 per cent. in five cases and between 25 and 50 per cent. in two cases; one case had a slight increase.

3. Loss of weight was frequent, occurring in 15 out of 20 patients. Observations of a control group suggested that other factors, such as diet, were responsible for this rather than epanutin. Nevertheless, gain in weight seemed to be prognostically favourable and any considerable loss unfavourable.

4. No change of blood pressure or composition of urine could be attributed to epanutin.

5. Blood counts showed no evidence of agranulocytosis or severe blood changes. An eosinophilia of between 4 and 12 per cent. occurred in a few cases, and in two cases a reduction of red blood cells occurred.

6. Toxic symptoms always occurred soon after introduction of epanutin or an increase in dosage.

7. The nature of exacerbation of fits and confusion and their correct treatment is worthy of note (see text).