Phenobarbital for childhood epilepsy: systematic review

Area of Science:

• Neurology
• Pharmacology
• Pediatrics

Background:

• Phenobarbital, an old antiepileptic drug (AED), is regaining interest due to safety concerns with newer pharmaceuticals.
• Its use has declined in Western countries due to debated adverse effect profiles, despite continued use in developing nations.

Purpose of the Study:

• To critically review the evidence on phenobarbital's effectiveness and behavioral adverse effects in febrile convulsions and childhood epilepsy.
• To assess the quality of existing randomized controlled trials (RCTs) on phenobarbital.

Main Methods:

• Systematic review of 11 RCTs for febrile convulsions and 9 RCTs for childhood epilepsy published between 1970-2005.
• Studies were evaluated against standard quality criteria, focusing on phenobarbital versus other AEDs or placebo.

Main Results:

• Overall methodology quality of the reviewed RCTs was poor, particularly older studies.
• No significant difference in antiepileptic efficacy was found between phenobarbital and other AEDs, nor evidence of absolute efficacy.
• Masked studies showed no excess behavioral or cognitive adverse effects for phenobarbital compared to other AEDs, contrary to open-label studies.
• A reduction in cognitive ability was noted with phenobarbital for febrile convulsions.

Conclusions:

• Phenobarbital demonstrates comparable efficacy to other AEDs for childhood epilepsy and febrile convulsions.
• Evidence does not support an excess of behavioral adverse effects with phenobarbital, especially in blinded trials.
• Further research is needed, particularly in clinical and genetic epidemiology.