Diphenylhydantoin and Intermittent Edema

To the Editor.—  I have recently seen a 16-year-old girl with edema of the legs and fingers, and puffiness of the face beginning about ten days before each menstrual period. Diuretics give no benefit. She becomes dizzy during these episodes of swelling and has fainted twice. Oral contraceptives have not helped.She has a brother and two paternal uncles who talk in their sleep; the mother used to have many fainting spells as a child; the patient herself talks in her sleep a great deal; she is on the high school honor roll and has always done well in school.Blood pressures are slightly asymmetric, right arm 135/95, left arm 120/85 mm/Hg. An electroencephalogram showed slightly poorly organized alpha rhythm, and occasional single alpha-frequency sharp waves in the occipital areas. Many other tests gave normal findings.When treated with diphenylhydantoin, 300 mg/day, a bizarre reaction developed in which she felt