Phenobarbital and Migraines

December 9, 2007 11:11 PM

From the age of 5 until 9, my doctor prescribed phenobarbital for my migraines. The headaches disappeared, but I'm wondering if there have been any long term studies done on the effects of phenobarbital on young children.

I can't remember what my oral dosage was, but I do recall, in excruciating detail, the awfulness of stopping the medication: depression, disorientation, a disconnect between my thoughts and my ability to speak them. I experienced these symptoms for some years afterward, but I don't know if there was any connection to the drug. Google isn't helping me much here. Anyone?

posted by maryh to Health & Fitness (6 answers total)

Phenobarbital is used for infant febrile seizures, so there are studies looking at followup. (The trick is to use google scholar.) It does look like there may have been long-term side-effects, although many of the studies were done in pediatric populations who received it younger than you did. (Ages 0-3 or 4.)

I can only get to a handful of articles right now - I can get more at work. It does look like there are some cognitive effects, as well as other systems (cholesterol, bone mineral uptake.)
posted by cobaltnine at 3:45 AM on December 10, 2007

My dog takes it too, for seizures. The most recent follow-up I had to do for him was a check of his liver to make sure there was not any liver damage resulting from the ongoing use of phenobarbital. Do children run that same risk?
posted by I_Love_Bananas at 3:49 AM on December 10, 2007

Best answer: Anticipatory Guidance in Pediatric Oral Health says:

"... Several medications cause gingival enlargements; for example, dilantin and phenobarbital, which are prescribed for epilepsy, can cause gingival hyperplasia. It is very important for a general health professional to be aware of these conditions: children with these conditions may need dental referrals on a regular basis. Like all children, these children should have their first visit within 6 months of eruption of the first tooth or at 12 months of age. However, future visits may have to be more frequent, maybe at 2-3 month intervals. Dental treatments may require additional time to accommodate the child's condition, medications, behavior, and complexity of care. Most important, these children should receive oral health care from those who have experience with this population. ..."

posted by paulsc at 3:58 AM on December 10, 2007

Best answer: Here's a summary of congnitive side effects from a newer article (Cognitive side effects of antiepileptic drugs in children. Neurology. 2004 Mar 23;62(6):872-7. Review.).

Children taking PB for seizure prophylaxis after a febrile seizure tend to have lower IQs or display IQ declines compared with control subjects, 13,14 although this difference does not always reach significance. 15 The effect of PB on IQ decreases after drug withdrawal, 13,14,16 and its negative effect on P300 latency (an electrophysiologic measure of cognitive processing speed) appears reversible after drug discontinuation. 17 Nevertheless, there may be lingering effects on academic achievement, even when tested 3 to 5 years later. 16 These longer-term effects suggest that many children do not fully catch up and compensate for “lost time” associated with decreased cognitive processing during PB therapy. Similar IQ effects have been described for children treated with PB for epilepsy (table). PB may decrease fine motor performance, although this effect may habituate. 18 Because of the effects of PB on attention, 19 measures such as performance IQ, in which there is a prominent timed component, often are decreased. 8,20 The negative effects of PB on cognition are greater than those of VPA 21,22 or CBZ. 23 These effects sometimes show up only as the absence of an expected practice effect with repeated assessment, an effect which is still present at least in part with CBZ and VPA. 22,24

In summary, PB may decrease IQ, although this results in part from decreased processing efficiency and poorer attention. Declines in IQ are thought to reflect slowed mental growth rather than loss of previously acquired cognitive function or cognitive regression, and the declines in speeded performance are largely reversible. However, the longer-term effects of PB on academic achievement suggest that many children never fully catch up after PB discontinuation.

It's the article isn't freely available, but I have nothing to do today and will email you the articles if you want.
posted by a robot made out of meat at 4:35 AM on December 10, 2007

I took PB from age 1-7 or thereabouts for seizures...Do you know the cholesterol side effects colbaltnine?
posted by moooshy at 9:14 PM on December 10, 2007

Response by poster: I'm sorry it's taken me so long to thank you, paulsc and a robot made out of meat, but your responses shook me up quite a lot. I was taking both dilantin and phenobarbital during those years, and I'm pretty sure I was misdiagnosed. The effects that robot quoted cast a light on the haziness I went through during grade school. Very unsettling... but thanks.
posted by maryh at 6:39 AM on December 11, 2007