There is no evidence for a difference in antiepileptic efficacy between phenobarbital and any other compared AED , yet no evidence for absolute efficacy .
No convincing evidence exists for an excess of behavioural adverse effects , over other AEDs , attributable to phenobarbital .
Masked studies of phenobarbital in childhood epilepsy have shown no significant differences in behavioural or cognitive adverse effects compared to other AEDs .
This is in contrast to the excess of such adverse effects reported in studies open to observer bias .
However , the one finding of reduction in cognitive ability associated with phenobarbital treatment for febrile convulsions remains a concern .
INTRODUCTION : Against a background of concern about the safety of new pharmaceutical products , there has been renewed interest in one of the oldest antiepileptic drugs ( AEDs ) , phenobarbital .
Although still in widespread use in developing countries , its popularity has slipped in Western countries over the past century , partly because of controversy about its adverse effect profile .
This critical review examines the evidence supporting its effectiveness and its associated behavioural adverse effects for febrile convulsions and childhood epilepsy .
Prevention of recurrent febrile convulsions--a randomized therapeutic assay: sodium valproate, phenobarbital and placebo.
The purpose of this study was to compare three different modes of treatment in the prevention of relapses of febrile convulsions  ( Phenobarbital = PH , Sodium Valproate = SV , Placebo = PO ) in a r and omized therapeutic trial . The patients included in the study had shown their first generalized convulsive seizure during a bout of fever ( greater than or equal to 38.5 degrees C ) and were aged between 6 months and 4 years . They were subsequently followed up as out patients , and Phenobarbital and sodium valproate levels were measured regularly to ascertain compliance with the treatment and to adjust the dosage accordingly . The patients ' families were question ed with respect to the occurrence of feverish bouts and convulsive seizures during the interval between visits , as well as possible adverse reactions . An  EEG  was carried out yearly . Results were as follows : - 69 patients - 35 boys and 34 girls - with an average age of 24 months were divided into 3 groups according to treatment : 21 cases on PH , 22 cases on SV , and 26 cases on PO . - they were followed up for an average duration of 21 months . - the average number of feverish bouts per child and per year was evaluated at 2.5 , no statistically significant difference being noticeable between the various modes of prophylaxis . - 15 relapses of febrile seizures were noted in 14 children , over an average duration of 23 months ; on average , relapses occurred after 9 months ; among the 14 children who had relapsed , one had been treated with SV , 4 with PH and 9 with PO , leading to estimated relapse rates of 4 % , 19 % , and 35 % respectively . There is a statistically significant difference in the relapse rates between the treated groups ( SV and PH ) and the Placebo group , and a particularly significant difference between Sodium Valproate and Placebo . ( ABSTRACT TRUNCATED AT 250 WORDS
There is no evidence for a difference in antiepileptic efficacy between phenobarbital and any other compared AED , yet no evidence for absolute efficacy .
No convincing evidence exists for an excess of behavioural adverse effects , over other AEDs , attributable to phenobarbital .
Masked studies of phenobarbital in childhood epilepsy have shown no significant differences in behavioural or cognitive adverse effects compared to other AEDs .
This is in contrast to the excess of such adverse effects reported in studies open to observer bias .
However , the one finding of reduction in cognitive ability associated with phenobarbital treatment for febrile convulsions remains a concern .
INTRODUCTION : Against a background of concern about the safety of new pharmaceutical products , there has been renewed interest in one of the oldest antiepileptic drugs ( AEDs ) , phenobarbital .
Although still in widespread use in developing countries , its popularity has slipped in Western countries over the past century , partly because of controversy about its adverse effect profile .
This critical review examines the evidence supporting its effectiveness and its associated behavioural adverse effects for febrile convulsions and childhood epilepsy .