Phenytoin exerts its anticonvulsant effect by blocking voltage-sensitive and frequency-dependent sodium channels in the neurons. Phenytoin stabilizes sodium channels in an inactive state, and this inhibitory effect, similar to the action of local anesthetics, is dependent on the voltage and frequency of firing of the neuron. Phenytoin has no effect on the amplitude or duration of the action potential. Rather, it limits the ability of the neuron to fire trains of action potentials at high frequency by delaying recovery. In this fashion, it suppresses repetitive neuronal activity and prevents the spread of a seizure focus. At higher concentrations, phenytoin delays activation of outward potassium currents in nerves and prolongs the neuronal refractory period. It may also exert an anticonvulsant effect by influencing calcium channels or g-aminobutyric acid (GABA) receptors, although this is not yet fully established.
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