phenobarbital / Generic mfg. - LARVOL DELTA

Chronic Ocular Complications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical Features and Surgical Management in a Brazilian Tertiary Center. (PubMed, Cornea) - "Our findings highlight the significant burden of severe ocular surface disease, the predominance of dipyrone as a causative drug in this population, and the need for complex surgical interventions in a significant proportion of cases. These results underscore the importance of early management of ocular complications, long-term follow-up, and access to advanced therapeutic strategies."

Journal • Dry Eye Disease • Inflammation • Ophthalmology • Steven-Johnson Syndrome • Transplantation

Reply: Safety of Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal in Critically Ill Patients With Primary Neurological Injuries. (PubMed, Ann Pharmacother) - No abstract available

Journal

Evaluation of Phenobarbital Loading Dose in Reducing Cumulative Benzodiazepine Utilization in Patients With Alcohol Withdrawal Syndrome. (PubMed, Ann Pharmacother) - "The addition of a weight-based PB loading dose showed a significant reduction in BZD utilization for patients in or at risk of severe AWS and was associated with fewer adverse events. Application of this information may aid in enhancing treatment for patients in or at risk of severe AWS."

Journal • CNS Disorders • Critical care • Depression • Hypotension • Psychiatry

Clinical Profile And Outcomes Of Neonatal Convulsions In The Neonatal Intensive Care Unit At Assiut University Children's Hospital (clinicaltrials.gov) - P=N/A | N=139 | Not yet recruiting | Sponsor: Assiut University

New trial • CNS Disorders • Critical care • Epilepsy

Effectiveness of gabapentin in combination therapy for phenobarbital-responsive sialadenosis in a Toy Poodle. (PubMed, J Vet Med Sci) - "Residual hypersalivation and retching almost completely resolved within 24 hr after gabapentin (GBP) addition, with only mild hypersalivation (about 10% of the initial level) remaining. No recurrence was observed during a 3-year follow-up, during which PB (3.6 mg/kg administered orally twice daily [PO BID]) and GBP (15 mg/kg PO BID) were continued at the same doses."

Journal • Movement Disorders • Pain

Implementing a Digital Neurocritical Care Unit for Neonates in Brazil: A 4-Year Experience. (PubMed, Am J Perinatol) - "A total of 47 (40.5%) neonates received antiseizure medications, with phenobarbital being the most frequently used (46; 97.9%)...· Abnormal aEEG/EEG findings are associated with poor outcomes.. · Remote aEEG/EEG monitoring is feasible in LMIC.."

Journal • CNS Disorders • Epilepsy

Severe cutaneous adverse reactions linked to medications in children and adolescents: a pharmacovigilance study based on the FDA Adverse Event Reporting System database. (PubMed, Int J Clin Pharm) - "SCARs in children and adolescents show distinct patterns, high hospitalization and mortality, and strong links with antiepileptics and anti-infectives. Strengthening pediatric pharmacovigilance, implementing risk-alert systems, and promoting genotype-guided prescribing may help prevent these severe reactions."

Adverse events • Journal • Eosinophilia • Pediatrics • Steven-Johnson Syndrome

Electrode Artifact, Breach Rhythm, or Focal Seizures: Navigating an Electrographic Quandary (AES 2025) - "Careful review of electrographic onset demonstrated that this rhythm, although still first seen in the left anterior temporal region (F7), progressed rapidly to the left frontopolar (Fp1) and central (C3), followed by spread to the left frontal region (F3) (Figure 1 D)...Despite escalation of antiepileptic therapy and use of anesthetic agents, seizures remained refractory (there was reduction in electrographic seizure burden after introducing Ketamine and Phenobarbital)... This case carries an important lesson for the neurophysiologist: Focal electrographic discharges recorded near a skull defect should not be dismissed as artifacts without further investigation. The use of extended EEG arrays, such as the 10–10 montage or additional anterior temporal electrodes, or imaging modalities such as MRI, may help resolve this diagnostic challenge. This is particularly crucial in the context of aggressive treatment of status epilepticus, as delays in treatment may potentially..."

Anesthesia • CNS Disorders • Epilepsy • Vascular Neurology

Phenobarbital for Refractory Behavioral Disturbances in Anti-NMDAR and HSV Encephalitis: A Case Report. (PubMed, J Pain Palliat Care Pharmacother) - "Disease-modifying therapies, including IV acyclovir, IV immunoglobulin, prednisone, and rituximab, were ineffective. Multiple psychotropic medications, including fluoxetine, quetiapine, olanzapine, and trazodone, failed to relieve behavioral symptoms...No adverse effects were reported. This case suggests that low-dose oral phenobarbital may be a viable option for managing refractory behavioral disturbances in patients and improving quality of life with anti-NMDAR and HSV encephalitis."

Journal • CNS Disorders • Herpes Simplex • Immunology • Insomnia • Mental Retardation • Palliative care • Psychiatry • Sleep Disorder

Loading phenobarbital in paediatric home-based terminal care: A case series. (PubMed, Palliat Med) - "Further research is needed on the administration of a loading dose of phenobarbital for managing terminal refractory symptoms in the paediatric palliative care population during the terminal phase. This will help to establish evidence-based guidelines for paediatric palliative sedation, ensuring appropriate relief of refractory symptoms for a peaceful death at home."

Journal • Anesthesia • Pain • Palliative care • Pediatrics

Dexmedetomidine for Alcohol Withdrawal: Looks Can Be Deceiving. (PubMed, Cureus) - "He received chlordiazepoxide, diazepam, and phenobarbital with resolution of his symptoms. He was later started on dexmedetomidine (0.2 mcg/kg/hr), with no other therapy, during which time he appeared sedated with a heart rate (HR) of 80 beats/minute, blood pressure (BP) of 126/80 mmHg, and respiratory rate (RR) of 18 breaths/minute...Maximal sedation was 50 mcg/kg/min of propofol and 14 mg/hr of midazolam...Although dexmedetomidine controls the autonomic instability and behavior associated with alcohol withdrawal, it does not address the underlying pathophysiology, leaving patients to suffer the psychological effects of withdrawal. The role of dexmedetomidine remains to be determined, with studies that address cognitive and long-term outcomes of alcohol withdrawal rather than just vital signs, behavior, and doses of other medications used."

Journal • Anesthesia • CNS Disorders • Critical care • Epilepsy

Antiseizure medication effects on the autonomic nervous system in pediatric patients with epilepsy. (PubMed, Epilepsy Res) - "Zonisamide and topiramate showed reduced sweating and increased temperature. In polytherapy patients, HRV decreased, with reductions in high-frequency (HF) values on valproic acid and low-frequency values on phenobarbital...Two studies reviewing the effect of levetiracetam found minimal short-term ANS effects within the ECG but improved parasympathetic control and restored balance in HRV parameters over time...A better understanding of how ASMs affect ANS is essential for assessing medication efficacy, side effects, and their role as confounders in seizure prediction. These biosignal data can support device-based neuromodulation, seizure detection, and prediction algorithms."

Journal • Review • CNS Disorders • Epilepsy • Novel Coronavirus Disease • Pediatrics

Network analysis of antiseizure medication use, efficacy, and safety in epilepsy: A retrospective cohort study in a tertiary care center. (PubMed, Epilepsy Behav Rep) - "Valproic acid remained the most frequently prescribed ASM, while levetiracetam use markedly increased (49 %)...The network analysis revealed clusters of ASMs commonly prescribed together that were associated with seizure freedom (valproic acid, lamotrigine, topiramate), whereas combinations including phenobarbital and lamotrigine were linked to more adverse effects...Despite advances in newer ASM use and improved seizure outcomes, adverse effects remain a concern. Continued monitoring of ASM combinations is warranted to better understand evolving treatment patterns and guide epilepsy management in resource-limited settings."

Journal • Retrospective data • CNS Disorders • Epilepsy

Seizure Burden Before and After Lidocaine as Add-on Therapy in (a)EEG-Confirmed Neonatal Seizures. (PubMed, Neonatology) - "Methods This single-center, retrospective cohort study included neonates with persistent seizures after phenobarbital who received add-on LDC therapy...Seizure freedom after LDC was achieved in 71% (42/59) for at least 24h and 52% (29/56) for 72h. Discussion LDC significantly reduced TSB and MSB in neonates with (a)EEG-confirmed seizures, achieving 100% seizure reduction in the majority, with half of the neonates remaining seizure-free for at least 72 hours."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Hematological Disorders • Infectious Disease • Ischemic stroke • Metabolic Disorders

Refractory tardive dyskinesia in the critical care setting: A case report of successful use of phenobarbital. (PubMed, SAGE Open Med Case Rep) - "Despite withdrawal of antipsychotics, a trial of deutetrabenazine, and high-dose tetrabenazine (150 mg/day for several weeks), symptoms persisted and significantly impaired critical care management. Given phenobarbital's activity on Gamma Aminobutyric Acid B receptors, its mechanism may involve modulation of GABAergic pathways implicated in the pathophysiology of tardive dyskinesia. Further investigation in clinical studies is warranted."

Journal • CNS Disorders • Critical care • Movement Disorders • Psychiatry • Schizophrenia

Cannabidiol potentiates phenobarbital effects in the control of pentylenetetrazole (PTZ)-induced epileptic seizures in neonate rats. (PubMed, Front Pediatr) - "However, CBD (30, 100, or 200 mg/kg) significantly enhanced the efficacy of a subeffective dose of PB (10 mg/kg). These results indicate a dose-dependent potentiation by CBD of PB effects, supporting the potential of CBD as an adjunct therapy for neonatal seizures."

Journal • Preclinical • CNS Disorders • Epilepsy

A Phase 2 Dose Escalation Study of Levetiracetam in the Treatment of Neonatal Seizures: Preliminary Results (AES 2025) - "Mounting evidence indicates that seizures contribute to brain injury and neurodevelopmental disability; better treatment may improve long-term neurodevelopmental outcomes. This FDA-funded NEOLEV3 clinical trial aims to refine the standard clinical paradigm for neonatal seizure treatment utilizing a stratified approach; using Levetiracetam (LEV) with its significantly improved side effect profile, targeted at reducing mild to moderate seizure burden, reserving Phenobarbital (PHB) with its associated side effects for neonates with high seizure burden. Phase 1 results were reviewed by the Data Safety Monitoring Board and demonstrated that LEV loading doses up to 90 mg/kg are safe for neonatal seizure treatment. In Phase 2, the first participant randomized to a 120 mg/kg total loading dose achieved seizure cessation without any unexpected adverse events, suggesting both the safety and potential efficacy of this higher dose; however, Phase 2 recruitment, data collection, and..."

Late-breaking abstract • P2 data • Cerebral Palsy • CNS Disorders • Developmental Disorders • Epilepsy • Psychiatry • Vascular Neurology

The Effect of Antiseizure Medications on Bone Mineral Density in Young Men with Epilepsy (AES 2025) - "Group 1 included 15 men who took first-generation ASMs (phenobarbital). Group 2 included 14 people who took second-generation ASMs (carbamazepine). Group 3 included 16 young men who took third-generation ASMs (levetiracetam)... Thus, the data obtained indicate that the problem of osteoporosis and osteopenia is relevant not only for women but also for young men suffering from epilepsy. Therefore, it is necessary to identify mineral metabolism disorders and bone tissue conditions in a timely manner, which requires subsequent adjustments to treatment and lifestyle. The issue of the impact of ASMs on bone mineral density in young men with epilepsy requires further in-depth study."

CNS Disorders • Epilepsy • Metabolic Disorders • Musculoskeletal Diseases • Orthopedics • Osteoporosis • Rheumatology

Mid-South Single Center Experience of Status Epilepticus with Autoimmune Encephalitis (AES 2025) - "The patient with anti-ganglionic nicotinic ACh receptor encephalitis presented with seizures along with focal motor weakness developed cardiac arrest possibly due to autonomic dysfunction [5], resuscitated and later improved with PLEX and IVIG followed by immunosuppression with mycophenolate mofetil. The seizures were treated predominantly with levetiracetam, lacosamide, phenobarbital and perampanel. Our retrospective case series study showed that despite having long ICU stay and ventilator days, 85% of the patients with new onset refractory status epilepticus due to autoimmune encephalitis improved with high dose steroids, PLEX and/ or IVIG except for one patient with anti-NMDA receptor positive with extreme delta brush pattern who died [3]. EBV IgG positive in CSF in one patient with anti-NMDA receptor encephalitis suggests the possibility of EBV infection being trigger for anti-NMDA encephalitis[4]."

Clinical • Cardiovascular • CNS Disorders • Epilepsy • Epstein-Barr Virus Infections • Immunology • Infectious Disease • Psychiatry • Respiratory Diseases

Vagus Nerve Stimulator Placement in a 7-Month-Old with GABRB3 Pathogenic Variant: A Case Report (AES 2025) - "Despite trials of multiple anti-seizure medications (Levetiracetam, Phenobarbital, Felbamate, Clobazam, and Lacosamide) and initiation of the ketogenic diet, seizures persisted ( >20/day) and were accompanied by developmental regression. This case illustrates the potential efficacy and tolerability of VNS in an infant under one year of age with drug-resistant epilepsy due to a GABRB3 pathogenic variant. The patient eventually became seizure free after VNS modification to rapid cycling and weaning all seizure medication. Although data remains sparse for this population, both the age and genetic variant, our findings support the consideration of VNS as an early intervention in infants under 1 year of age with medically refractory epilepsy."

Case report • Clinical • CNS Disorders • Epilepsy

Using Seizure Dynamotypes to Predict Response to Antiseizure Medications (AES 2025) - "Also: Undergraduate Research Opportunities Program at the University of Utah, NIH NINDS: F32 NS114322 awarded to Daria Anderson and University of Utah Skaggs Fellowship awarded to Ashley Zachery-Savella Rationale: Epilepsy treatment is complicated by the fact that patients with similar phenotypes and seizure classifications do not respond similarly to the same treatments, suggesting subtler differences exist that cannot be accounted for by our currently-limited classification system... We analyzed seizure frequency and dynamotype in six treatment cohorts: 294 seizures/21 animals in the carbamazepine (30 mg/kg, t.i.d.) cohort, 820 seizures/17 animals in the phenobarbital (PB, 50 mg/kg, b.i.d.) cohort, 848 seizures/22 animals in the valproate (VPA, 240 mg/kg, t.i.d.) cohort, and 825 seizures/21 animals in the phenytoin (PHT, 20 mg/kg, b.i.d.) cohort... Dynamotype analysis reveals drug-specific modulation of seizure onset and offset patterns. PHT did not reduce seizure..."

CNS Disorders • Epilepsy

From Burst Suppression to Normal EEG: A Pediatric Case of STEC-HUS with Multifocal Seizures and Reversible Deep Gray Matter Injury (AES 2025) - "Seizures were managed with intravenous levetiracetam, phenobarbital and midazolam drips.Brain MRI demonstrated restricted diffusion in the bilateral thalami, caudate nuclei, globus pallidi, and posterior brainstem (tegmentum from medulla to midbrain), suggestive of toxic-metabolic injury secondary to systemic inflammation, uremia, and potential Shiga toxin neurotoxicity...Residual symptoms were limited to transient neuropathic leg pain managed with gabapentin. This case illustrates the fulminant neurological impact of STEC-HUS and the potential reversibility of profound EEG and MRI abnormalities... This case illustrates the fulminant neurological impact of STEC-HUS and the potential reversibility of profound EEG and MRI abnormalities. Continuous EEG was essential for seizure detection and monitoring recovery. Parallel evolution of neuroimaging and EEG findings supports the use of both modalities in prognostication."

Clinical • Acute Kidney Injury • Atypical Hemolytic Uremic Syndrome • CNS Disorders • Epilepsy • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Nephrology • Pediatrics • Renal Disease

Fenfluramine in Refractory Status Epilepticus and Acute Repetitive Seizures: Promising Clinical Results (AES 2025) - "Both were on midazolam infusions; one also received phenobarbital infusion. In this small retrospective series, fenfluramine was associated with clinical improvement in seizure control in some patients with SRSE and acute repetitive seizures. It facilitated the reduction or discontinuation of anesthetic agents. Given its manageable safety profile and observed benefits, FFA may be considered as a therapeutic option in treatment-resistant SE."

Clinical • Anesthesia • CNS Disorders • Epilepsy • Metabolic Disorders • CARS1 • CARS2 • TSC2

Efficacy, Safety, and Pharmacokinetics of Lacosamide in Neonates With Seizures: Results of a Phase 2/3, Open-Label, Randomized, Active Comparator Trial (AES 2025) - P2 | "The AC treatments received were phenobarbital (5 [41.7%]), fosphenytoin (5 [41.7%]), and levetiracetam (2 [16.7%]). In this first randomized clinical trial of LCM in neonates, LCM treatment reduced seizure burden and was well tolerated. Although LCM exposure tended to be higher in neonates, serum concentrations were generally in agreement with exposure in adults at a dose of 400 mg/day LCM (without use of inducers)."

Clinical • P2/3 data • PK/PD data • CNS Disorders • Epilepsy

Long-Term Efficacy of Lacosamide in the Treatment of Early-Onset Epilepsy: A Case Series (AES 2025) - "All patients presented in SE that was unresponsive to standard first-line therapies including lorazepam, fosphenytoin, phenobarbital, and in some cases, oxcarbazepine or levetiracetam. This case series supports the safety and potential efficacy of lacosamide in managing early-onset epilepsy, particularly in infants presenting with refractory SE. The rapid resolution of seizures and the absence of cardiac conduction abnormalities, combined with favorable long-term outcomes, suggest that lacosamide may be a valuable addition to the early treatment algorithm for infantile epilepsy2. Further prospective studies with larger cohorts are warranted to confirm these findings and to establish optimal dosing protocols in this vulnerable population."

Clinical • CNS Disorders • Epilepsy