الفهرس 
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Abstract
were screened according to the following lines:
1- complete blood picture to exclude megaloblasic anaemia
which has been thought to result from prolonged treatemnt with
phenytoin.
2-
Complete
liver
functions to exclude those with
malfunctionig liver as the drug is mainly metsbolised in the
liver.
3-
Complte
renal
profile
to
exclude
those with
hypoalbuminaemia; the diminution of its concentration might alter
its cabability of binding the drug and consequently produces
misleading serum concentrations of phenytoin if its assessment is
needed.
4- Electroencephalogaphic screening to verify the type of
epilepsy the patient is harbouring.
5- A detailed thoughrly conduted neurological examination
to exclude gross neurological deficits.
6-
A
detiledand
thoughrly
conducted
psychiatric
examination
with special emphasis on cognitive functions to
exclude any functionl psychiatric disorder accompanyig the seizure
disorder.
.
7- Full inquiry about the family histor of the patient,
particlarly if there is a history of a functional psychiatric
disorder in a first degree relative.
Out of about 200 epileptic patients with different varieties and aetiologies, only 91 patients fitted exactly into the criteria of specification determined before hand.
In summary, the patients were chosen to be representing only cases of major motor tonic-clonic convulsions of the primary generalised type as prooved by the medical history, clinical examination and electroencephalographic studies.
The specification of selection of these 91 patints to fulfill the criteria of primary generalised epilepsy were mentioned in details in the ”METHODS” section of this monograph.
The 91 patients were divided into three groups accoring to the duration of their epileptic illness.
Group I had the ilness for one year or less. Group II had the illness for a minimum of 1 years and maximum of 2 years. Group 3 had the illness for a minimum of 2 years and a maximum of four years.
The changed to are seizure
anticonvulsant diphenylhyantoin free and serum
treatment of all participants was in an ethical way, provided patients concentration of DPH is within the
internationally accepted therapeutic range (40-80 mmol/L or 10-20 ug/ml.
The study was carried at two steps. First all patients had had their serum concentration of phenytoin assesd followed by application of the neuropsychological battery designed mainly for
assessment of memory functions of this sample of epileptic
patients.
After six months of full clinical seizure control,
the same procedure was repeated,again~ i.e. assessment of serum
level concentration of neuropsychological battery.
phenytoin Observed
and
repeating
the
data on individual basis
gave the impression that there was a progressive improvement of the patients whether with regard to clinical seizure control, serum level of phenytoin or the scores they gained on different neuropsychological tests.
Actual statistical analysis of the raw data using
Visitrend~Visiplot
software
computer program revealed the
results which were mentioned in details in the ”RESULTS” section of this thesis. Without going again into much tedious statistical details, the follOWing generalizations can be made:
1- Memory functions of this selec~ed sample of epileptic patients were dependant in the first place upon seizure frequency. The higher the average number of seizures to which a patient was subjected to, the poorer were his memory functions.
2- On the otherhand, both age of patient at the time of the stUdy and the duration of $pileptic illness representing the age of onset of epilepsy were not found to correlate with the memory funct.ions of our epileptic pat.ients.
3- With regard to serum phenytoin concentration, it was found that phenytoin did not. affect any of the memory funct.ions tested when its serum level was maintained within the therapeutic range.
As mentioned before, most studies have been conducted on deteriorated epileptics or on epileptics in whom the serum phenytoin level was Within the toxic range. The results of such studies were naturally not in accordance with ours. The few studies which used our same criteria concluded that phenytoin 1S not toxic to memory functions when its level is within the therapeutic range. These results are in agreement of our results.
Bearing in mind that phenytoin serum level was kept always within the therapeutic range while monitoring the memory functions of our epileptic patients, this fact in itself confirms the validity of the therapeutic range of phenytoin
4- As regards the neuropsychological battery applied, the follOWing deductions can be made:
a) Visual Number Span Test CMS2):
This test did not correlate in any significant way with any of the independant variables under research. This suggests that this test is not suitable for discriminating memory deficits in epileptics. It might be useful for other groups of patients.
b) Shape Memory Test CMVl):
This test correlated significantly in a positive way only with the level of education. This suggests that its results can be biased by practice effects due to repeated learning and higher level of education.
Therefore, we suggest that the test might not be as suitable for testing memory functions of illiterate epileptics or those with lower levels of education~ It is particularly not suitable in situations in which test/retest is needed.
c) Maze Tracing Speed Test (SS1) and
d) Form Board Test (VZi):
Both of these tests were found to corr-el ate negat i vel y the main variable under research which is seizure
with
frequency.
In addition they were sensitive enough to detect