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Phenobarbital for febrile seizures--effects on intelligence and on seizure recurrence

J R Farwell1, Y J Lee, D G Hirtz

  • 1University of Washington School of Medicine, Seattle.

The New England Journal of Medicine
|February 8, 1990
PubMed

Insights

Phenobarbital treatment for febrile seizures in children may lower IQ scores. These cognitive effects might persist even after discontinuing the medication, without improving seizure control.

Area of Science:

  • Pediatric Neurology
  • Clinical Pharmacology

Background:

  • Phenobarbital is a common treatment for pediatric febrile seizures.
  • Concerns exist regarding potential behavioral and cognitive adverse effects.

Purpose of the Study:

  • To evaluate the impact of phenobarbital on cognitive development in children with febrile seizures.
  • To compare intelligence quotients (IQs) between children treated with phenobarbital and those receiving a placebo.

Main Methods:

  • A randomized controlled trial involving 217 children aged 8–36 months with a history of febrile seizures.
  • Daily phenobarbital doses (4–5 mg/kg) were administered to one group, while the other received a placebo.
  • Cognitive assessments (IQs) were conducted after two years and six months post-treatment discontinuation.

Main Results:

  • After two years, the phenobarbital group showed a mean IQ 7.03 points lower than the placebo group (P=0.0068).
  • Six months after discontinuing phenobarbital, the mean IQ remained lower by 5.2 points (P=0.052).
  • No significant difference in seizure recurrence was observed between the groups.

Conclusions:

  • Phenobarbital use in treating febrile seizures is associated with a significant depression in cognitive performance.
  • The observed cognitive disadvantage may persist for months after drug cessation.
  • The cognitive impairment is not compensated by improved seizure prevention benefits.

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