Phenobarbitone: Indian Epilepsy Society- Consensus Document

Epilepsy is a common neurological disorder affecting 65 million people worldwide and approximately more than 12 million in India. Two-third of the people with epilepsy lives in resource-limited countries. Phenobarbitone was the first anti-epileptic drug (AED) used in 1912 and has been in use for more than 100 years now. Its low cost and favorable cost-efficacy ratio, which is lower than any other AED in current use, makes the drug particularly suitable for use in the low- and middle-income countries. [[1]] The World Health Organization (WHO) recommends phenobarbitone as a first-line treatment for convulsive seizures in resource-poor countries and includes it in its Essential Drug List. [[2]] However, the use of phenobarbi-tone is largely limited owing to the concerns regarding its cognitive and behavioral side effects especially in children. This article summarizes the current role of phenobarbitone in the treatment of epilepsy.

[Tables 1]-[5]

• References

• 1 Ilangaratne NB, Mannakkara NN, Bell GS, Sander JW. Phenobarbital: missing in action. Bull World Health Organ 2012; 90: 871-871A
• 2 World Health Organization. Division of Mental Health. Initiative of Support to People with Epilepsy. Geneva: World Health Organization; 1990. (document WHO/MNH/MND/90.3)
• 3 Rogawski MA, Porter RJ. Antiepileptic drugs: pharmacological mechanisms and clinical efficacy with consideration of promising developmental stage compounds. Pharmacol Rev 1990; 42: 223-286
• 4 Twyman RE, Rogers CJ, Macdonald RL. Differential regulation of g-amino butyric acid receptor channels by diazepam and Phenobarbital. Ann Neurol 1989; 25: 213-220
• 5 Seeman P. Membrane actions of anesthetics and tranquilizers. Pharmacol Rev 1972; 24: 583-656
• 6 Booker HE. Phenobarbital. Relation of plasma concentration to seizure control. In: Antiepileptic Drugs Woodbury DM, Penry JK, Pippenger DE. (Eds.) New York: Raven Press; 1982: 341-50
• 7 Wilmshurst JM, van Toorn R. Use of phenobarbitone for treating childhood epilepsy in resource-poor countries. S Afr Med J 2005; 95: 392-394, 396
• 8 Gursahani R. Phenobarbitone in modern India. J Assoc Physicians India 2013; 61 (08) Suppl 45-47
• 9 Pal DK. Phenobarbital for childhood epilepsy: systematic review. Paediatr Perinat Drug Ther 2006; 7: 31-42
• 10 Glauser T, Ben-Menachem E, Bourgeois B. et al Updated ILA. evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013; 54: 551-563
• 11 Kwan P, Brodie JM. Invited review: phenobarbital for the treatment of epilepsy in the 21st century: a critical review. Epilepsia 2004; 45: 1141-1149
• 12 NICE guidelines update 2013. The diagnosis and management of the epilepsies in adults and children in primary and secondary care. Available at: http://www.nice.org.uk/guidance/cg137/resources/guidance-theepilepsies-the-diagnosisand-management-of-theepilepsies-in-adults-and-children-in-primary-andsecondary-care-pdf (Accessed on 12th October 2014).
• 13 Mewasingh LD. Febrile seizures. Clin Evid (Online) 2010; 2010: pii-0324
• 14 Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev 2012; CD003031
• 15 Goldberg MA, McIntyre HB. Barbiturates in the treatment of status epilepticus. Adv Neurol 1983; 34: 499-503
• 16 Treiman DM, Meyers PD, Walton NY. et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998; 339: 792-798
• 17 Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine-resistant convulsive status epilepticus: a metaanalysis of published studies. Seizure 2014; 23: 167-174
• 18 Brigo F, Igwe SC, Nardone R. et al. A common reference-based indirect comparison meta-analysis of intravenous valproate versus intravenous phenobarbitone for convulsive status epilepticus. Epileptic Disord 2013; 15: 314-323
• 19 Tiamkao S, Mayurasakorn N, Suko P. et al. Very high dose phenobarbital for refractory status epilepticus. J Med Assoc Thai 2007; 90: 2597-2600
• 20 Lee WK, Liu KT, Young BW. Very-high-dose phenobarbital for childhood refractory status epilepticus. Pediatr Neurol 2006; 34: 63-65
• 21 Crawford TO, Mitchell WG, Fishman LS, Snodgrass SR. Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology 1988; 38: 1035-1040
• 22 Tomson T, Battino D, Bonizzoni E. et al. EURAP Study Group. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol 2011; 10: 609-617
• 23 Kwan P, Brodie MJ. Phenobarbital for the treatment of epilepsy in the 21st century: a critical review. Epilepsia 2004; 45: 1141-1149
• 24 Tripathi M, Jain DC, Devi MG. et al. Need for a national epilepsy control program. Ann Indian Acad Neurol 2012; 15: 89-93
• 25 Brodie MJ, Kwan P. Current position of phenobarbital in epilepsy and its future. Epilepsia 2012; 53 (Suppl (08) 40-46
• 26 Kale R, Perucca E. Revisiting phenobarbital for epilepsy. BMJ 2004; 329: 1199-1200