High-dose phenobarbital with intermittent short-acting barbiturates for acute encephalitis with refractory, repetitive partial seizures.
Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by repetitive seizures during the acute and chronic phases and has a poor neurological outcome. Burst-suppression coma via continuous i.v. infusion of a short-acting barbiturate is used to terminate refractory seizures, but the severe side-effects of short-acting barbiturates are problematic. We report on a 9-year-old boy with AERRPS who was effectively treated with very-high-dose phenobarbital (VHDPB) combined with intermittent short-acting barbiturates. VHDPB side-effects were mild, especially compared with those associated with continuous i.v. infusion of short-acting barbiturates (dosage, 40-75 mg/kg/day; maximum blood level, 290 μg/mL). Using VHDPB as the main treatment, short-acting barbiturates were used intermittently and in small amounts. This is the first report to show that VHDPB, combined with intermittent short-acting barbiturates, can effectively treat AERRPS. After treatment, convulsions were suppressed and daily life continued, but intellectual impairment and high-level dysfunction remained.
Division of Pediatrics, Sendai City Hospital, Sendai, Japan.
Takashi
T
Uchida
Division of Pediatrics, Sendai City Hospital, Sendai, Japan.
Masaru
M
Takayanagi
Division of Pediatrics, Sendai City Hospital, Sendai, Japan.
Taro
T
Kitamura
Division of Pediatrics, Sendai City Hospital, Sendai, Japan.
Toshiyuki
T
Nishio
Department of Pediatrics, Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
Yurika
Y
Numata
Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan.
Wakaba
W
Endo
Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan.
Kazuhiro
K
Haginoya
Division of Pediatrics, Sendai City Hospital, Sendai, Japan.
Toshihiro
T
Ohura
D000208:Acute Disease; D000927:Anticonvulsants / Q000008:administration & dosage; D001463:Barbiturates / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010634:Phenobarbital / Q000008:administration & dosage*; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
D000927:Anticonvulsants; D001463:Barbiturates; C032232:barbituric acid; D010634:Phenobarbital
barbiturates; encephalitis; febrile seizure; partial seizure disorder; phenobarbital