Sleeping medication with an antiepileptic effect
In 1912, phenobarbital had recently appeared on the market as a sleeping medicine branded as Luminal. At the time, a young German psychiatrist from Freiburg, Alfred Hauptmann, was living on the floor above patients who suffered from epilepsy and psychiatric disorders. They were exceedingly noisy at night, so he decided to give them phenobarbital so that he himself would be able to sleep. To his great surprise he found that not only did the patients sleep better – many no longer had epileptic seizures (6).
Even though he published his findings, phenobarbital did not become a drug of first choice against epilepsy until around 1920, perhaps because his article was published in German (7). It was not until 70 years later, in 1979, that the most important molecular mechanism behind the drug's seizure-inhibiting effect was identified – it lengthens the opening of the chloride channel in the GABAA-receptor.
Even though phenobarbital undoubtedly works well against generalised tonic-clonic seizures, its use has gradually decreased in recent years, mainly due to its unfavourable side effect profile. However, the drug is cheap, and its long half-life means it is effective even if taken only once a day. In a global perspective, phenobarbital is still an important antiepileptic drug, particularly in developing countries (8), and it features on the World Health Organisation's List of Essential Medicines (9).