The Efficacy of Once-Daily Dose of Phenobarbital in Children with Generalized Tonic-Clonic Epilepsy

  • Amril A. Burhany Pediatric Neurology Division, "Harapan Kita" Children's & Maternity Hospital, Jakarta
  • Sofyan Ismael Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Hardiono Pusponegoro Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Keywords: phenobarbital; generalized tonic clonic epilepsy; epilepsy

Abstract

In spite of its long half life, phenobarbital is still given twice-daily in the treatment of generalized tonic-clonic epilepsy. This study aims to determine if daily dose of phenobarbital given once differs to that given twice daily. Subjects of this unblinded controlled clinical trial were generalized tonic-clonic epilepsy patients ranging in age from 1-15 years. There were 40 study cases and 42 controls. We gave phenobarbital 4-6 mg/kg/day once-daily for study group and twice-daily dose for control group. History, physical and EEG examination and phenobarbital plasma measurements were obtained a t the beginning of the study and four weeks later. The ratio of the second to first phenobarbital plasma concentrations in the study group was 0.99 while in the control group it was 1.02. The proportion of seizure-free patients in the study group increased from 70% at the beginning to 85% at the end of study, and in the control group from 64.3% to 83.3%. Hyperactivity and irritability increased in both groups, and there were no significant differences in mean serum levels, seizures control, hyperactivity and irritability in both groups. Drowsiness was found in 50% of cases, but statistically significant decrease were found in study group. The compliance of the study group (92.5%) was significantly better than that of the control group (71.4%).

References

1. Sofuanov NG. Clinical evolution and prognosis of childhood epilepsies. Epilepsia 1982;23: 61-9.
2. Shmvon SD. Epilepsy, a general practice perspective; 1st ed. Basel: Ciba Geigy; 1988. p. 2-5.
3. Gilman AG, Goodman LS, Rail TW, et al. Drugs effective in the therapy of epilepsies. In: Goodman LS, Gilman AG, eds. The pharmacological basis of therapeutics; 7th ed. New York: Macmillan Publishing, 1985;446-72.
4. lsmael S. The efficacy of phenobarbital in controlling epilepsy in children. Paediatr lndones 1990; 30:97-110.
5. Garrettson LK, Dayton PG. Disappearance of phenobarbital and diphenylhydantoin from serum of children. Clin Pharmacal Ther 1970;11: 674-9.
6. Heimann G, Gladtke E. Pharmacokinetics of phenobarbital in childhood. Eur J Pharmacal 1977; 12:305-10.
7. Walson PD, Mimaki T, Curless R, et al. Once-daily doses of phenobarbital in children. J Pediatr 1980; 97 303-5.
8. Davis AG, Mutchie KD, Thompson JA, et al. Once-daily dosing with phenobarbital in children with seizure disorders. Pediatrics 1981; 68:824-7.
9. Cornmision on classification and tenninology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epilepstic seizures. Epilepsia 1981; 22:489-501.
10. Wada T. Clinical studies in epilepsy, especially criteria of the recent drug therapy (Psychiatria Neural Jap 1960;62: 399), cited by Fukuyama, Arirna, Nagatha et al. Medical treatment of epilepsies in childhood, a long-term survey of 801 patients. Epilepsia 1963;4:207-24.
11. Shmvon SO. Epidemiology, classification, natural history and genetics of epilepsy. Lancet 1990; 336:93-6.
12. Jailing B. Plasma and cerebrospinal fluid concentrations of phenobarbital in infants given single doses. Dev Med Child Neurol1974;16:781-93.
13. Boreus W. The role of therapeutic drug monitoring in children. Clin Pharrnacokinet 1989;17 (Suppl) 1:4-12.
14. Lampe KF. Antiepileptic drug. In: Drug evaluation; 6th ed. Chicago: American Medical Association, 1986; 169-95.
15. Taylor WJ, Dierslaviness MH. Antiepileptic drugs. In: A textbook for the clinical application of therapeutic drug monitoring; 1st ed. Texas: Irving, 1986;237-52.
16. Taylor WJ, Finn AL. Individualizing drug therapy, clinical notes on the applications of drug monitoring; 1st ed. New York: Gross, 1981;38-41.
17. Wolf SM, Forsythe A. Behaviour disturbance, phenobarbital and febrile seizures. Pediatrics 1978; 61:728-31.
18. Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology, the essentials; 2nd ed. Baltimore: Williams & Wilkins, 1988; 129-56.
19. Vining EPG, Mellits ED, Dorsen MM, et al. Psychologic and behavioral effects of antiepileptic drugs in. children, a doubleblind comparison between phenobarbital and valproic acid. Pediatrics 1987; 80: 165-74.
Published
2018-10-08
How to Cite
1.
Burhany A, Ismael S, Pusponegoro H. The Efficacy of Once-Daily Dose of Phenobarbital in Children with Generalized Tonic-Clonic Epilepsy. PI [Internet]. 8Oct.2018 [cited 27Jun.2022];35(7-8):172-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1982
Section
Pediatric Neurology
Received 2018-10-08
Published 2018-10-08