Use of phenobarbitone for treating childhood epilepsy in resource-poor countries

Abstract

Should the continued use of phenobarbitone for childhood epilepsy in resource-poor countries be considered a form of discrimination? Phenobarbitone was recommended by the World Health Organization (WHO) as the first-line agent for the control of seizures,1 but this has been contested on the grounds that it is biased against resource-poor countries.2 It was first used as an anticonvulsant in 1912, but now has little role to play in First-World countries where the newer generation agents are readily accessible. Phenobarbitone monotherapy has equivalent efficacy to the newer anticonvulsants (phenytoin, sodium valproate and carbamazepine) in children with partial-onset and generalised tonic-clonic seizures.3 Phenobarbitone is cheap, readily available, and easy to use and store. However, it has definite cognitive and behavioural side-effects in many children. It can exacerbate seizures in about 35% of children, and extreme caution should be taken with children who have a pre-morbid state of behavioural problems or attention deficit hyperactivity disorder (ADHD).