Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus

Area of Science:

• Pediatric Neurology
• Clinical Pharmacology
• Emergency Medicine

Background:

• Parenteral phenobarbitone, a critical treatment for status epilepticus, faced unavailability in South Africa from 2005 to 2006.
• This situation necessitated exploring alternative administration routes for effective seizure management in children.

Purpose of the Study:

• To evaluate the efficacy and safety of enteral phenobarbitone for treating childhood status epilepticus.
• To establish adequate phenobarbitone exposure and seizure control using the enteral route.

Main Methods:

• A prospective study involving pediatric patients with status epilepticus who received a 20 mg/kg enteral phenobarbitone loading dose via nasogastric tube.
• Standard status epilepticus interventions, including benzodiazepine boluses and phenytoin infusion, were administered concurrently.
• Phenobarbitone concentrations were measured post-administration, and population pharmacokinetics were analyzed using non-linear mixed-effects modeling.

Main Results:

• Sixteen pediatric patients (median age 5 months) were assessed.
• Seizure control was achieved within 1 to 4 hours in all patients following enteral phenobarbitone loading.
• No adverse effects were observed, and therapeutic phenobarbitone concentrations were achieved, indicating good drug exposure.

Conclusions:

• Enteral phenobarbitone loading was well-tolerated and demonstrated effectiveness in managing childhood status epilepticus.
• This administration route provides a safe and viable alternative for centers lacking parenteral phenobarbitone.
• Enteral phenobarbitone shows potential for both acute status epilepticus management and prophylaxis against seizure recurrence.