title: Exacerbation of benign familial neonatal epilepsy induced by massive doses of phenobarbital and midazolam.
abstract: BACKGROUND
  Barbiturates and benzodiazepines are the first-line anticonvulsants for neonatal seizures. However, in immature brains, those drugs may lead to paradoxical neuronal excitation.
  
  
  METHODS
  A patient with benign familial neonatal epilepsy developed epileptic encephalopathy after massive doses of phenobarbital that were followed by a continuous infusion of midazolam on postnatal day 3. Electroencephalography revealed rhythmic delta activity in clusters with migrating epileptic foci. After discontinuation of both drugs, the patient's consciousness promptly improved and her electroencephalography normalized on postnatal day 5.
  
  
  RESULTS
  This baby developed persistent electroencephalographic seizures due to massive doses of phenobarbital and midazolam.
  
  
  CONCLUSIONS
  Clinicians should be aware of this anticonvulsant-induced paradoxical neuronal excitation and the uncoupling phenomenon, especially in individuals with benign familial neonatal epilepsy, who have low seizure thresholds.
authors: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan. Electronic address: tmaeda@oita-u.ac.jp.
authors: Tomoki
authors: T
authors: Maeda
authors: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
authors: Miki
authors: M
authors: Shimizu
authors: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
authors: Kazuhito
authors: K
authors: Sekiguchi
authors: Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan.
authors: Atsushi
authors: A
authors: Ishii
authors: Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan.
authors: Yukiko
authors: Y
authors: Ihara
authors: Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan; Central Research Institute for the Pathomechanisms of Epilepsy, Fukuoka University, Fukuoka, Japan.
authors: Shinichi
authors: S
authors: Hirose
authors: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
authors: Tatsuro
authors: T
authors: Izumi
mesh_terms: D004569:Electroencephalography; D020936:Epilepsy, Benign Neonatal / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D005260:Female; D018757:GABA Modulators / Q000009:adverse effects*; D006801:Humans; D008874:Midazolam / Q000009:adverse effects*; D010634:Phenobarbital / Q000009:adverse effects*; D012640:Seizures / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D018757:GABA Modulators; D008874:Midazolam; D010634:Phenobarbital
keywords: amplitude-integrated electroencephalography; benign familial neonatal epilepsy; midazolam; paradoxical exacerbation; phenobarbital; uncoupling phenomenon