Neurocognitive behavior in 9 children with various epilepsies was evaluated before and at 6 months after discontinuing phenobarbital monotherapy at the Department of Child Neurology, Instituto Nazionale Neurologico “Carlo Besta;” Milano, Italy. The patients had been seizure-free for at least 2 years. All of the scores on the WISC improved and the mean Performance IQ was significantly higher after phenobarbital was withdrawn. Other tests showing significant improvement included the general information subtest on the Verbal IQ picture arrangement on the Performance IQ visual spatial memory, and visual-motoric and attentional skills, as measured by coding and the Trail Making test. [1]

COMMENT. In this small number of children treated, phenobarbital appeared to have impaired attention, spatial memory, and visual/motor skills. The deficits were reversible and disappeared when phenobarbital was discontinued.

Drowsiness secondary to chronic antiepileptic drug therapy was assessed in 30 patients, using an EEG-based Awake Maintenance Task (AMT) measure, and reported from the Portland Veterans Affairs Medical Center, and Oregon Health Sciences University, Portland, Oregon [2]. Ability to maintain wakefulness was determined during a 6-min unstimulated trial. One third of AED-treated patients had >120 s of drowsiness in contrast to only 1 of 63 controls. Objective EEG drowsiness did not correlate with AED levels or performance measures. Untreated seizure patients had more complaints of lack of vigor despite absence of objective drowsiness on the AMT. Subjective reports of AED-related drowsiness may be unreliable.