Friday, 23 November 2012

Chinese doctors show "outdated" anti-epilepsy drug may still be the best

Phenobarbital was an effective anti-epileptic drug when used in rural China

by Michael Woodhead
Phenobarbital  should not be dismissed as an out-of-date drug for epilepsy because  it is still highly effective and well tolerated, Chinese researchers have shown.
Researchers from the Beijing Neurosurgical Institute analysed the effects of phenobarbital in a trial that involved almost 2500 people with epilepsy in rural China.
They found that 25% became seizure-free for at least one year while taking phenobarbital, 88% of whom did so at daily doses of 120mg or below. At a follow-up assessment, almost 40% of patients had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking anti-epileptic treatment irregularly before the trial were less likely to become seizure-free. Overall, half the patients continued taking phenobarbital. The most common reasons for stopping phenobarbital were freedom from seizures or substantial seizure reduction and being unable to afford the drug. About 23% of patients reported adverse events, which led to withdrawal of phenobarbital in less than 1%. The most common adverse effects were malaise/somnolence (7%), dizziness (3%), and lethargy (2.6%).
The researchers conclude that there are still long-term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China.
"One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy," they say.
"Despite the subsequent availability of more than 20 drugs for the treatment of epilepsy, phenobarbital, introduced in 1912, remains the most widely prescribed AED worldwide. Its propensity for cognitive and behavioral adverse effects are of concern, but it has many potential advantages including reliability of supply, affordable cost, broad spectrum of action, and ease of use
They say their findings "have relevance for the implementation of similar intervention programs in other resource-poor settings where the great majority of people with epilepsy live. O
Read more: Epilepsia

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