EFFECTS OF LONG BARBITURATE ANESTHESIA ON 8 CHILDREN WITH SEVERE EPILEPSY

Frequent epileptic seizures in children are often related to delayed p sychomotor development, and status epilepticus is always a neurologica l emergency. In both situations barbiturate anaesthesia has been used for status epilepticus since the 1960s, and for intractable seizures i n children since the 1980s. However, the clinical results on the effec tiveness of barbiturate anaesthesia in children with chronic epileptic disorders remain contradictory. Between 1986 and 1991 in Tampere Univ ersity Hospital in Finland long barbiturate anaesthesia was introduced - using thiopentone sodium - to eight children with very severe epile psy. Children were 10 months to 7 years 11 months of age and the mean time from the onset of seizures to the introduction of BA was 2 years 8 months. Effects upon seizure frequency, antiepileptic medication and /or psychomotor development were clearly positive in three patients, s lightly positive in one patient and in four patients there was no effe ct. Good effect seemed to be associated with an anaesthesia which is d eep and long enough to produce loss of consciousness and spontaneous r eactions, and an electro-encephalographic pattern of burst-suppression . Positive results were also more often achieved when the treatment la g was less than 12 months. Physical and neurophysiological properties of barbiturates make their effectiveness as anticonvulsants understand able, but there is only little evidence to explain the mechanism of th is action.