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 .
The value of phenobarbital in the child who has had a single febrile seizure: a controlled prospective study.
A group of 355 children who were seen after a first febrile convulsion at the Kaiser Foundation Foundation Hospitals in Southern California from 1970 to 1975 were r and omly assigned to three treatment groups-daily phenobarbital , " intermittent " phenobarbital given at the onset of fever , and no phenobarbital . We found that 42 % had a relative with a febrile seizure and 16 % a relative with an afebrile convulsion . 13 % had seizures which were either lateralized or longer than ten minutes . Parents were unaware of the fever prior to the seizure in about 30 % of the cases . In 81 % the preseizure duration of fever was less than 24 hours . The mean follow-up was 28 months , with a range of 6 to 70 months . There was no significant difference in the recurrence rate between children receiving " intermitent " as compared with no phenobarbital . The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other two groups . Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4 % of the children receiving either intermittent or no phenobarbital .  Parental resistance , compliance , and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen
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 .