Case 66 - The Continuing Place of Phenobarbital

Abstract

This chapter presents a case in which the patient was diagnosed with a syndrome of familial epilepsy with nocturnal recurrences. This male patient experienced his first seizure in 1978 at the age of 15. It was a generalized convulsion that occurred early in the morning during sleep and lasted approximately 5 min, as have all of his subsequent seizures. EEG was abnormal and his family doctor initiated phenobarbital 120 mg/day. The phenobarbital dose was raised to 180 mg/day after his second seizure 9 months later. Over the next 12 years, in consultation with a neurologist, he attempted further phenobarbital dosage reductions down to 200 mg daily, but breakthrough seizures occurred and the dose was continued at 300 mg/day. The neurologist felt that the patient's quality of life would be better with a different medication, and initiated carbamazepine. When the carbamazepine dose reached 800 mg/day, the phenobarbital dose was reduced by 50 mg every 3 weeks. Phenobarbital was discontinued and he had several additional seizures over the next few months. Lamotrigine was added and titrated over 2 months to 400 mg/day in two divided doses, and carbamazepine was reduced to 800 mg/day in two divided doses. On a regimen of phenobarbital 100 mg/day, carbamazepine 200 mg/day and lamotrigine 400 mg/day in two divided doses, he suffered from tiredness but his seizures were completely controlled.