Phenobarbital for the treatment of epilepsy in the 21st century: a critical review

Epilepsia. 2004 Sep;45(9):1141-9. doi: 10.1111/j.0013-9580.2004.12704.x.


Phenobarbital (PB) is the most widely used antiepileptic drug (AED) in the developing world and remains a popular choice in many industrialized countries. Meta-analyses of randomized controlled trials suggest that few differences in efficacy exist between PB and other established AEDs, but its possible deleterious cognitive and behavioral side effects remain a concern in the developed world. In contrast, high degrees of efficacy and tolerability in everyday clinical use have been demonstrated consistently in observational studies in developing countries. We propose that a pragmatic, comprehensive outcomes program be carried out, perhaps under the aegis of the Global Campaign Against Epilepsy, to optimize the conditions of the use of PB, so that more people around the world can benefit from this cost-effective medication and live more fulfilling lives.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anticonvulsants / adverse effects
  • Anticonvulsants / economics
  • Anticonvulsants / therapeutic use*
  • Cost-Benefit Analysis
  • Developing Countries / economics
  • Drug Costs
  • Epilepsy / drug therapy*
  • Female
  • Global Health
  • Humans
  • Infant, Newborn
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • Neurotoxicity Syndromes / etiology
  • Phenobarbital / adverse effects
  • Phenobarbital / economics
  • Phenobarbital / therapeutic use*
  • Phenytoin / therapeutic use
  • Randomized Controlled Trials as Topic
  • Status Epilepticus / drug therapy
  • Treatment Outcome


  • Anticonvulsants
  • Phenytoin
  • Phenobarbital