Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria; Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision-Making and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
Epilepsy Behav. 2023 Apr;141:109104. doi: 10.1016/j.yebeh.2023.109104. Epub 2023 Feb 18.
Phenobarbital (PB) is one of the oldest Antiseizure Medicines (ASMs), which is in clinical use since 1912. Its value in the treatment of Status epilepticus is currently discussed controversially. Phenobarbital has fallen out of favor in many countries across Europe because of reports of hypotension, arrhythmias, and hypopnea. Phenobarbital has a strong antiseizure effect with remarkably little sedation. It exerts its clinical effects, through the increase of GABE-ergic inhibition and decrease of glutamatergic excitation by inhibition of AMPA receptors. Despite good preclinical evidence, there are remarkably few randomized controlled studies on humans in SE, which suggest, that it is at least as good as lorazepam in first-line treatment in early SE, and significantly better than valproic acid in benzodiazepine-resistant SE. Data from randomized trials and large non-randomized prospective and retrospective studies suggest, that Phenobarbital is well tolerated even if used in very high dose protocols. Thus, despite its decline in its popularity at least in Europe and North America, it should be considered a highly cost-effective treatment for early and established SE, not only in resource-limited settings. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
苯巴比妥（PB）是最古老的抗癫痫药物（ASMs）之一，自 1912 年以来一直在临床使用。其在治疗癫痫持续状态中的价值目前存在争议。由于低血压、心律失常和低通气的报道，苯巴比妥在欧洲许多国家已经不再受欢迎。苯巴比妥具有很强的抗惊厥作用，镇静作用很小。它通过抑制 AMPA 受体来增加 GABA 能抑制和减少谷氨酸能兴奋来发挥其临床作用。尽管有很好的临床前证据，但在 SE 中，针对人类的随机对照研究却很少，这些研究表明，在早期 SE 中，它至少与劳拉西泮一样作为一线治疗药物，并且在苯二氮䓬类药物耐药性 SE 中明显优于丙戊酸。来自随机试验和大型非随机前瞻性和回顾性研究的数据表明，即使使用非常高剂量的方案，苯巴比妥也能很好地耐受。因此，尽管它在欧洲和北美至少已经不再流行，但它应该被认为是治疗早期和已确立的 SE 的一种非常具有成本效益的治疗方法，不仅在资源有限的环境中如此。本文在 2022 年 9 月举行的第八届伦敦因斯布鲁克癫痫持续状态和急性发作学术研讨会上发表。
