Barbiturate-refractory epilepsy: safe schedule for therapeutic substitution

Abstract

Barbiturates are considered first line antiepileptic drugs in third world countries due to traditional and economic reasons. This prospective uncontrolled study of 52 patients aged 15 to 64 years (mean 24) demonstrates that patients who become refractory to barbiturates are mainly those with partial seizures with or without generalization or with a focal EEG abnormality (71%). Seizures tend to become refractory approximately 6 years after barbiturates were started. Progressive barbiturate withdrawal over a period of two to 8 months (mean 5) with institution of treatment with carbamazepine, phenytoin or sodium valproate allowed complete barbiturate withdrawal in 42 of the 52 patients (81%). Furthermore monthly seizure frequency in those in whom barbiturates were withdrawn decreased from 7.1 to 1.7 per patient. An improvement in mental status was observed but not measured. These results show that barbiturates should not be first-choice drugs in patients who have a chronic disease such as epilepsy, and indicate a schedule for barbiturate withdrawal which is safe and independent of hospitalization or monitoring of antiepileptic drug serum concentrations.

Vigabatrin: Clinical Evidence Supporting Rational Polytherapy in Management of Uncontrolled Seizures

“…To perform an initial evaluation of VGB under this concept, we selected a homogenous group of ''socially integrated and active outpatients" receiving a minimal number of other AEDs rather than the more typical patients with chronic epilepsy and polytherapy recruited into previous studies (Matilainen et al, 1988;Sander et al, 1990;Reynolds et al, 1991). In addition to the major AEDs, such chronic patients were often receiving maximal doses of BZDs and/or barbiturates, known to induce tolerance (Gorz et al, 1986;Bittencourt et al, 1993) and cognitive impairment (Thompson, 1981 ;Bigarella et al, 1991). We believed that the patient population of our study was one in which any benefit from such rational polytherapy could be measured.…”