Barbiturates in the treatment of epilepsy in people with intellectual disability.
Phenobarbital often worsens behavior in people with ID and epilepsy—clinicians are moving away from it despite seizure control.
01Research in Context
What this study did
Alvarez (1998) looked at old charts and papers about phenobarbital in people with intellectual disability and epilepsy.
The review asked: Does the drug stop seizures, and what does it do to mood, learning, and daily living?
What they found
Phenobarbital controls seizures but often makes people groggy, irritable, or slow to think.
Because of these side effects, the paper says most clients with ID should avoid this drug.
How this fits with other research
Three other 1998 reviews paint a fuller picture. Willemsen-Swinkels et al. (1998) show carbamazepine keeps seizures away while sparing memory and mood. Iivanainen (1998) warns that phenytoin, like phenobarbital, can cloud thinking. Kerr (1998) and Ruiz (1998) add topiramate and tiagabine as newer choices with milder mental side effects.
Burack et al. (2004) extend the theme by giving you simple checklists to watch for drug side effects during regular sessions.
Together the papers push the field away from phenobarbital and toward medicines that protect both seizure control and behavior.
Why it matters
If a client with ID takes phenobarbital and you see new self-injury or slowed learning, the drug could be the cause. Share your data sheets with the medical team and ask about switching to carbamazepine or another safer option. Your notes on behavior can guide dose changes and improve quality of life without losing seizure protection.
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02At a glance
03Original abstract
Barbiturates are effective drugs in the treatment of epileptic disorder. The systemic side-effects are minimal. The main limiting factor is the presence of cognitive and behavioural problems. Relevant research is presented in this paper; however, it is somewhat difficult to extrapolate some of these experiences to a population of children and adults with intellectual disability and epilepsy. Recent reviews of this subject have suggested that, although the cognitive deficiencies seem to be a serious problem when phenobarbital is given in high doses, the problem is much less severe when the doses are on the low side. The most consistent findings with regard to behaviour are the exacerbation of behaviour disorders (mostly hyperactivity), as well as sleep disorders and depression in individuals who already have a predisposition to these disorders. However, the clinical experience of many professionals involved with the care of people with intellectual disability strongly suggests that barbiturates, and especially phenobarbital, produces intolerable side-effects at the point that the use of phenobarbital has been reduced to a minimum, and it is no longer considered a drug of choice. It is probably that the simultaneous presence of brain damage, epilepsy, intellectual disability and psychiatric disorders in people with intellectual disability is responsible for the high incidence of behaviour problems observed by clinicians.
Journal of intellectual disability research : JIDR, 1998 · doi:n/a