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Late cognitive effects of early treatment with phenobarbital
S Sulzbacher1, J R Farwell, N Temkin
1Department of Psychiatry, University of Washington School of Medicine, Seattle, USA.
Insights
Phenobarbital treatment for febrile seizures may cause long-term cognitive deficits in children. Follow-up testing revealed lower reading scores in the phenobarbital group, suggesting potential adverse effects on developmental skills.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
Background:
- Previous research indicated phenobarbital lowered IQ in toddlers with febrile seizures.
- No difference in febrile seizure recurrence was observed between phenobarbital and placebo groups.
Purpose of the Study:
- To assess long-term cognitive effects of phenobarbital treatment for febrile seizures.
- To determine if early cognitive effects persist into school age.
- To evaluate the impact on later school performance.
Main Methods:
- Follow-up testing of 139 children originally treated for febrile seizures.
- Comparison of Wide Range Achievement Test (WRAT-R) reading scores and Stanford-Binet IQ scores between phenobarbital and placebo groups.
- Assessment of afebrile seizure occurrences post-treatment.
Main Results:
- Phenobarbital group had significantly lower WRAT-R reading achievement standard scores (87.6 vs 95.6; p = 0.007).
- A nonsignificant trend for lower IQ scores in the phenobarbital group on the Stanford-Binet (102.2 vs 105.7; p = 0.09).
- No significant difference in the rate of afebrile seizures between groups.
Conclusions:
- Phenobarbital may have long-term adverse cognitive effects on language and verbal skills.
- No beneficial effect on febrile seizure recurrence or later nonfebrile seizures was found.
- Early phenobarbital exposure may negatively impact developmental trajectories.
Abstract:
We previously reported that IQ was significantly lowered in a group of toddler-aged children randomly assigned to receive phenobarbital or placebo for febrile seizures and there was no difference in the febrile seizure recurrence rate. We retested these children 3-5 years later, after they had entered school, to determine whether those effects persisted over the longer term and whether later school performance might be affected. On follow-up testing of 139 (of the original n = 217) Western Washington children who had experienced febrile seizures, we found that the phenobarbital group scored significantly lower than the placebo group on the Wide Range Achievement Test (WRAT-R) reading achievement standard score (87.6 vs 95.6; p = 0.007). There was a nonsignificant mean difference of 3.71 IQ points on the Stanford-Binet, with the phenobarbital-treated group scoring lower (102.2 vs 105.7; p = 0.09). There were five children in our sample with afebrile seizures during the 5-year period after the end of the medication trial. Two had been assigned to phenobarbital, and three had been in the placebo group. We conclude there may be a long-term adverse cognitive effect of phenobarbital on the developmental skills (language/verbal) being acquired during the period of treatment and no beneficial effect on the rate of febrile seizure recurrences or later nonfebrile seizures.