Seizures during barbiturate withdrawal: Relation to blood level

Theodore, William H.; Porter, Roger J.; Raubertas, Richard F.

doi:10.1002/ana.410220515

Cited by 35 publications

(17 citation statements)

References 23 publications

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“…Another study, however, failed to mention previous AEDs as playing a role in SE in 52 children (Yager et al, 1988). Theodore et al (1987) found no relationship between the rate of PB discontinuation and seizure frequency. In these studies it should be noted that the patients had been receiving AEDs for prolonged periods of time prior to drug discontinuation, while our patients had received AEDs for an average of only 15 days before abruptly stopping.…”

Section: Discussionmentioning

confidence: 95%

Allergic Rash Due to Antiepileptic Drugs: Clinical Features and Management

Pelekanos

Camfield

et al. 1991

Epilepsia

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Optimal management of allergic rash from antiepileptic drugs (AEDs) is unclear. We identified 50 patients with 68 reactions (36 to one AED, 10 to two AEDs, and four to three AEDs). The AEDs implicated were carbamazepine, 30; phenobarbital (PB), 20; phenytoin, 16; ethosuximide, one; and AED combination, one. Sixty-three reactions were cutaneous eruptions, three exfoliative dermatitis, and two Stevens-Johnson syndrome. Forty-six reactions were mild (rash only), 18 moderate (systemic symptoms or other organ system involvement), and four life-threatening (all with PB). In most patients with greater than 1 reaction, the second and third reactions were not more severe than the first. Prior antibiotic allergies or nonmedication allergies were no more common than in a control group without reactions. The AED was ceased abruptly in 59 patients (22 of whom did not receive a new AED), tapered in five, and continued unchanged in four. Despite this, there was no status epilepticus (SE) during the reaction or its treatment, and no patient's seizure control deteriorated. In 40 cases, a new AED was added--16 after the reaction had resolved and 24 before total resolution. Rash recurred with the new AED in 50 and 42% respectively (NS). We conclude that, though allergic rashes to AEDs are usually mild, the rare occurrence of severe reactions indicates that the AED should be ceased. This can be done abruptly with minimal risk of SE. A new AED can be added, if necessary, prior to the resolution of the rash without increasing the risk of further reactions.

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Section: Discussionmentioning

confidence: 95%

Allergic Rash Due to Antiepileptic Drugs: Clinical Features and Management

Pelekanos

Camfield

et al. 1991

Epilepsia

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“…The bioavailability of oral PB is more than 95% and the peak blood level of PB is 0.5–4 h. The t 1/2 of PB is 2–7 days [85]. Discontinuing PB should be done with caution because a case report showed an increase of seizure frequency in patients tapering the doses of PB while stabilized on another AED [86]. Twenty-five percent of PB is cleared by renal excretion in unchanged form [87].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

Fan

Lee

Chang

et al. 2016

IJMS

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Epilepsy is a common neurological disorder worldwide and anti-epileptic drugs (AEDs) are always the first choice for treatment. However, more than 50% of patients with epilepsy who take AEDs have reported bone abnormalities. Cytochrome P450 (CYP450) isoenzymes are induced by AEDs, especially the classical AEDs, such as benzodiazepines (BZDs), carbamazepine (CBZ), phenytoin (PT), phenobarbital (PB), and valproic acid (VPA). The induction of CYP450 isoenzymes may cause vitamin D deficiency, hypocalcemia, increased fracture risks, and altered bone turnover, leading to impaired bone mineral density (BMD). Newer AEDs, such as levetiracetam (LEV), oxcarbazepine (OXC), lamotrigine (LTG), topiramate (TPM), gabapentin (GP), and vigabatrin (VB) have broader spectra, and are safer and better tolerated than the classical AEDs. The effects of AEDs on bone health are controversial. This review focuses on the impact of AEDs on growth and bone metabolism and emphasizes the need for caution and timely withdrawal of these medications to avoid serious disabilities.

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“…A previous study reported an increase seizure frequency in patients tapered from PB or primidone, while stabilized on another anti-epileptic drug (AED) [4]. Our report is the first study in a patient who had been seizure-free for several years before the initiation of the PB taper and who once again became seizure-free after full PB discontinuation.…”

Section: Introductionmentioning

confidence: 67%

Phenobarbital withdrawal seizures may occur over several weeks before remitting: Human data and hypothetical mechanism

Bidlack

Morris

2009

Seizure

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Summary This case is the first report of a patient who had phenobarbital (PB) withdrawal seizures after having been seizure-free for three years following temporal lobe surgery. The patient had been taking PB for 14 years when a gradual taper of PB was started. When PB was at 60 mg/d, a titration of lamotrigine (LTG) was started. However, typical complex seizures occurred when the patient was on PB 60 mg/d, along with LTG 25 mg/d. PB was increased back to 90 mg/d and levetiracetam (LEV) was titrated. Seizures appeared when the patient was on PB 30 mg/d and LEV 750 mg BID and continued for three weeks after PB was stopped and the patient was on LEV 1000 mg BID. For the following six months, her aura frequency remained elevated in comparison to her baseline aura of two auras per month for the previous year before the start of the PB taper. She was followed for 24 months after her last PB withdrawal seizure. During the last eight months, her aura frequency returned to her baseline. As suggested by animal studies, the PB withdrawal seizures and increase in aura frequency in this patient may be explained by changes in her levels of GABAA receptor subunits.

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Seizures during barbiturate withdrawal: Relation to blood level

Cited by 35 publications

References 23 publications

Allergic Rash Due to Antiepileptic Drugs: Clinical Features and Management

Allergic Rash Due to Antiepileptic Drugs: Clinical Features and Management

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

Phenobarbital withdrawal seizures may occur over several weeks before remitting: Human data and hypothetical mechanism

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