Phenobarbitone vs. phenytoin for partial onset seizures and generalized onset tonic-clonic seizures

There is probably no difference between phenytoin and phenobarbitone in the control of the seizure types investigated, but phenytoin is less likely to be withdrawn, presumably because due to fewer adverse effects.

A Cochrane review included 4 studies with a total of 599 subjects. Phenobarbitone was significantly more likely to be withdrawn than phenytoin (HR 1.62, 95% CI 1.22 to 2.14). These results indicate a statistically significant clinical advantage for phenytoin in terms of treatment withdrawal, which may be due to adverse effects. Time to 12 month remission favoured phenytoin but statistical significance was not reached (HR 0.93, 95% CI 0.70 to 1.23). Time to first seizure favoured phenobarbitone but did not reach statistical significance (OR 0.84, 95% CI 0.68 to 1.05).

Comment: The quality of evidence is downgraded by study quality (lack of blinding) and imprecise results (few patients and wide confidence intervals).

Ədəbiyyat

1. Nolan SJ, Tudur Smith C, Pulman J et al. Phenobarbitone versus phenytoin monotherapy for partial onset seizures and generalised onset tonic-clonic seizures. Cochrane Database Syst Rev 2013;1():CD002217. .