Neonatal seizures: continued debate on phenobarbitone versus phenytoin.

Authors of a recent paper [1] concluded that phenobarbitone is more efficacious than phenytoin in control of clinical seizures in term or near-term neonates. However, it has been inferred from apparent misinterpretation of data. The preponderance of seizure type was subtle seizure, which should not be considered as clinical seizure equivalent. Authors themselves mentioned of observations by Mizrahi, et al. [2] that near 85% of subtle seizures may not have electrophysiological correlate and may represent brainstem release phenomenon. Authors also reported that 91.6% neonates had normal interictal EEG. Phenobarbitone due to its GABA mimetic property may be effective in these events. So, for a pragmatic study design with lack of video EEG facility, at least subtle seizures should be excluded from study. Additionally, authors have defined cessation of clinical seizure activity as primary outcome variable, but lack of defining timeline threatens its internal validity. Also, authors should have reported seizure recurrences in each intervention arm.