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 .
PLACEBO-CONTROLLED STUDY OF PHENOBARBITONE AND PHENYTOIN IN THE PROPHYLAXIS OF FEBRILE CONVULSIONS
Of 138 children who had a first febrile convulsion before their second birthday , 48 were treated with phenobarbitone  , 47 with phenytoin , and 43 with a placebo for 12 months . Drug levels were monitored and adverse effects of the drugs were noted . Compared with placebo , phenobarbitone significantly reduced recurrences among children under 14 months old at the time of their first convulsion , but nor among older children . Phenytoin was an ineffective prophylactic agent . Ideal drug levels were difficult to maintain , and many recurrences occurred when concentrations were suboptimal . Behavioural disturbance in children taking phenobarbitone was not a serious problem . The decision to give continuous prophylaxis for febrile convulsions is complex , and each case must be judged on its merits . For children who have a first seizure before 14 months of age prophylaxis may be advisable and phenobarbitone is effective
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 .