BMJ  2004;329:1199-1200 (20 November), doi:10.1136/bmj.329.7476.1199

Editorial

Revisiting phenobarbital for epilepsy

Large gaps in knowledge still exist, but we may be underestimating its clinical value

The first 150 words of the full text of this article appear below.

A recent review of phenobarbital for the treatment of epilepsy draws attention to an ethical dilemma and to the many gaps in our knowledge about a drug that has been in use since 1912.¹ Phenobarbital is commonly prescribed in the developing world, but in most developed countries it has fallen into disrepute. The World Health Organization (WHO) recommends it as a first line drug for partial and generalised tonic-clonic seizures in developing countries.² Its antiepileptic efficacy is undisputed, but concerns remain about its side effects.¹ If people with epilepsy in Britain are not prescribed phenobarbital because of its toxicity, is it ethical to recommend its use in developing countries? And if the drug is not as toxic as it is believed to be, might it not be used more in the developed world?

Phenobarbital has many favourable features: broad spectrum efficacy against all seizure types other than absences; a starting . . . [Full text of this article]

BMJ (rkale@bmj.com)

Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Via Mondino 2, I-27100 Pavia, Italy

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