Neurocognitive Effects of Phenobarbital Discontinuation in Epileptic Children

Tonekaboni, Seyed Hasan; Beyraghi, Narges

doi:10.1055/s-2006-945949

Cited by 13 publications

(15 citation statements)

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“…In a systematic review of phenobarbital for childhood epilepsy, the author concluded that there was no evidence of adverse behavioral effects with this drug compared to other AEDs (Pal, 2006). There were no apparent differences in IQ or Wechsler Intelligence Scales in 22 seizure-free children in whom phenobarbital was withdrawn in Taiwan (Chen et al, 2001), whereas in an Iranian study the authors reported a small improvement in neuropsychiatric performance, mainly in nonverbal rather than verbal items, in 24 seizure-free children who stopped phenobarbital (Tonekaboni et al, 2006).…”

Section: Tolerabilitymentioning

confidence: 98%

Current position of phenobarbital in epilepsy and its future

2012

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SUMMARYThis article reviews the current position of phenobarbital using articles published since 2000 and speculates on its likely future contribution to epilepsy care. Over the last decade there have been no major double-blind randomized placebo-controlled or comparative trials with phenobarbital. Previous studies have suggested that phenobarbital is as effective in monotherapy as phenytoin and carbamazepine. Several observational studies undertaken in developing countries over the last decade have confirmed its efficacy and safety for the common epilepsies. This was particularly so in the substantial demonstration project undertaken in rural China under the auspices of the World Health Organization in partnership with the International League Against Epilepsy and International Bureau for Epilepsy. Phenobarbital is still widely used for neonatal and childhood seizures and for drug-resistant convulsive and nonconvulsive status epilepticus. Recent data have confirmed in a prospective cohort of women taking phenobarbital as monotherapy that the drug can be associated with a range of congenital defects in exposed infants. Much effort has gone into exploring the apparent contradiction of higher withdrawal rates due to cognitive and behavioral side effects in studies undertaken in developed countries but not in those sited in the developing world. A raft of data over the last 10 years, including a systematic review, showed no important differences between the tolerability of phenobarbital compared to that with other antiepileptic drugs. Finally, cognitive test scores and mood ratings in 136 people with epilepsy receiving phenobarbital for a year were similar to those in 137 age-, sex-, and education-matched controls in a number of Chinese villages. Indeed, there were some cognitive gains in the patients possibly due to improved seizure control. Phenobarbital is still the most cost-effective pharmacologic treatment for epilepsy. All these data predict a healthy future for phenobarbital, particularly in helping to close the treatment gap in low-and middle-income countries during its second century of clinical use.

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Section: Tolerabilitymentioning

confidence: 98%

Current position of phenobarbital in epilepsy and its future

2012

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“…The effects of AEDs on language functioning have not been well-reported in the literature and, in fact, with older AEDs, language functioning appears to remain mostly unaffected (Tonekaboni et al, 2006). However, more recent research with some of the newer AEDs is providing evidence of preferential effects on language processing.…”

Section: Language Functioningmentioning

confidence: 98%

“…Many of the early studies on cognitive side effects with AED treatment used IQ as an outcome measure and therefore provided an imprecise picture of the cognitive changes being observed. That is, although overall IQ was found to be affected, closer inspection suggested preferential effects on aspects of performance IQ because of the higher demands on processing speed (e.g., Tonekaboni, Beyraghi, Tahbaz, Bahreynian, & Aghamohammadpoor, 2006). Longer term studies suggest that the negative effects of phenobarbital treatment on IQ are due to a general slowing in development rather than regression, and the effects are reversible with discontinuation (Yung-Jung, Chow, & Lee, 2001).…”

Section: Intelligencementioning

confidence: 99%

The effects of antiepileptic drugs on classroom performance

Titus¹,

Thio²

2009

Psychology in the Schools

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Epilepsy is one of the most common neurological disorders in children, and it has been associated with an increased risk of cognitive, psychiatric, and learning problems. Although side effects of antiepileptic drugs (AEDs) have been long studied in adults, an understanding of how they manifest in children is only beginning to emerge. Careful clinical considerations must be made to accurately determine the potential contribution of AEDs to learning problems, and this includes understanding the complex role played by multiple medical, developmental, and psychosocial factors. The present review provides information on common cognitive and psychiatric side effects of AED treatment in children, with consideration of classroom accommodations and strategies that may be helpful to circumvent these difficulties. © 2009 Wiley Periodicals, Inc.

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“…23 In a comparison study, the discontinuation of phenobarbital improved the total IQ score in the case group compared with the control group, mostly in nonverbal performance skills, with verbal skills remaining almost unchanged. 24 More information on studies that are focused on the cognitive side effects of AEDs in children can be obtained from Loring and Meador 25 and Aldenkamp and colleagues. 26 …”

Section: Effect Of Aedsmentioning

confidence: 99%