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The efficacy of phenobarbital in controlling epilepsy in children
1Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta.
Insights
Phenobarbital remains a valuable first-line epilepsy treatment in developing nations due to its availability and low cost. This study found good results in over 60% of patients, demonstrating its continued efficacy.
Area of Science:
- Neurology
- Pharmacology
- Global Health
Background:
- New antiepileptic drugs are often inaccessible and costly in developing countries.
- Phenobarbital is a readily available and affordable alternative for epilepsy management.
Purpose of the Study:
- To evaluate the efficacy and safety of phenobarbital as a first-line antiepileptic drug in a developing country setting.
- To assess treatment outcomes based on seizure types, neurological status, and EEG findings.
Main Methods:
- A cohort of 117 epilepsy patients (excluding infantile spasms) were treated with phenobarbital as a first-line therapy.
- Patients were followed up for 6 months to 10 years, with outcomes categorized as good, fair, or poor.
- Data analysis included seizure type, neurological status, and EEG examination results.
Main Results:
- Overall, phenobarbital achieved good results in 62.40% of patients, with fair results in 7.69% and poor results in 29.91%.
- Higher efficacy was observed in grand-mal (72.60%), absences (60%), and complex partial seizures (43.75%).
- Favorable outcomes correlated with normal neurological status and absence of EEG spikes; side effects were rare.
Conclusions:
- Phenobarbital is a safe and effective first-line treatment for epilepsy, particularly in resource-limited settings.
- Its accessibility and low cost make it a crucial option for managing epilepsy in developing countries.
- Despite potential disadvantages, phenobarbital's benefits outweigh risks for many epilepsy patients.
Abstract:
Most of the new anti epileptic drugs are hard to find and expensive to be used in developing countries. We prefer phenobarbital as the first line drug because it is easily available and quite cheap. In 1986 we had 117 cases of epilepsy, excluding infantile spasms, that were treated with phenobarbital as the first line drug and had been followed up regularly from 6 months to 10 years. The cases consisted of 54 boys and 63 girls; the age of the initial visit varied between 5 months and 12 years. Overall, good results were obtained in 73 cases (62.40%), fair result in 9 cases (7.69%) and poor in 35 cases (29.91%). In relation to the type of seizures, good results occurred in 72.60% of grand-mal type, 60% of absences, 43.75% of complex partial seizures and 47.05% of partial seizures secondarily generalized. The results in myoclonic and akinetic types were poor to fair. Better results were also found in group with normal neurological status and in group without spikes in EEG examination. In only 2 cases had their phenobarbital discontinued due to its intolerable side effects. Otherwise, the only indication to change phenobarbital to other anticonvulsant was the persistence of seizures for more than 75%. We concluded that in spite of its disadvantages, phenobarbital is still good to be used as the first line drug in the treatment of epilepsy, especially in developing countries.