Farwell J R, Lee Y J, Hirtz D G, Sulzbacher S I, Ellenberg J H, Nelson K B
University of Washington School of Medicine, Seattle.
N Engl J Med. 1990 Feb 8;322(6):364-9. doi: 10.1056/NEJM199002083220604.
Phenobarbital is widely used in the treatment of children with febrile seizures, although there is concern about possible behavioral and cognitive side effects. In 217 children between 8 and 36 months of age who had had at least one febrile seizure and were at heightened risk of further seizures, we compared the intelligence quotients (IQs) of a group randomly assigned to daily doses of phenobarbital (4 to 5 mg per kilogram of body weight per day) with the IQs of a group randomly assigned to placebo. After two years, the mean IQ was 7.03 [corrected] points lower in the group assigned to phenobarbital than in the placebo group (95 percent confidence interval, -11.52 to -2.5, P = 0.0068 [corrected]). Six months later, after the medication had been tapered and discontinued, the mean IQ was 5.2 points lower in the group assigned to phenobarbital (95 percent confidence interval, -10.5 to 0.04, P = 0.052). The proportion of children remaining free of subsequent seizures did not differ significantly between the treatment groups. We conclude that phenobarbital depresses cognitive performance in children treated for febrile seizures and that this disadvantage, which may outlast the administration of the drug by several months, is not offset by the benefit of seizure prevention.
苯巴比妥被广泛用于治疗高热惊厥儿童，尽管人们担心其可能产生行为和认知方面的副作用。在217名年龄在8至36个月之间、至少有过一次高热惊厥且再次惊厥风险较高的儿童中，我们将随机分配至每日服用苯巴比妥（每日每公斤体重4至5毫克）组的儿童智商与随机分配至安慰剂组的儿童智商进行了比较。两年后，服用苯巴比妥组的平均智商比安慰剂组低7.03[校正后]分（95%置信区间为-11.52至-2.5，P = 0.0068[校正后]）。六个月后，在药物逐渐减量并停药后，服用苯巴比妥组的平均智商低5.2分（95%置信区间为-10.5至0.04，P = 0.052）。治疗组之间后续无惊厥发作的儿童比例没有显著差异。我们得出结论，苯巴比妥会降低接受高热惊厥治疗儿童的认知表现，且这种劣势可能在药物停用后持续数月，不会因预防惊厥的益处而得到弥补。
