Clash of the Titans: Phenobarbitone vs Phenytoin

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Parents are desperate to save their newborn diagnosed with neonatal seizures that causes long-term brain damage. Successful treatment of neonatal seizures in India is yet unachieved for want of deft drugs and ready access to EEG monitoring. Hence, an open label randomised control trial was conducted in a North Indian Level II neonatal government medical college to compare efficiency of phenobarbitone and phenytoin to alleviate neonatal seizures.

109 newborn manifesting neonatal seizures and non-responder to hypoglycaemia and hypocalcemia treatments were recruited. 55 randomized babies in group A received IV infusion of Phenytoin, then injected with phenobarbitone if seizures persisted. Randomized 54 newborns in group B were first treated with phenobarbitone, followed up with phenytoin on relentless seizures.  Additional, newborn with unrelenting seizures were administered higher dose of phenobarbitone. Anticonvulsants save phenobarbitone were stopped on 5 day seizure-free babies while latter was discontinued at discharge of newborn.

14.5 % and 72.2% babies responded to phenytoin and phenobarbitone, respectively. Those babies who didn’t respond to first line drugs showed 80% and 91% improvement respectively at cross over of drugs. The EEG rates were normal in 91.6% while 8.4% babies exhibited ‘burst suppression’ causing abnormal EEG. Phenobarbitone and phenytoin induced-side-effects killed 13 and 16 neonates, respectively.   Maximum dose of phenobarbitone successfully kept seizures at abeyance in 44/55 and 52/54 newborns. Thus, phenobarbitone achieved success in controlling seizures in neonates irrespective of aetiology.

Source: Pathak G et al. Phenobarbitone and phenytoin for treatment of neonatal seizures: Open-label randomized controlled trial. Indian Pediatr 2012;