I read with interest the article by Miller et al1 in the February 1993 issue ofAJDC. Primidone was administered to infants with apnea that was resistant to theophylline. Hematocrit values, glucose levels, and calcium levels of the infants were normal. Nine had normal cranial sonograms, three had evidence of grade 1 or 2 hemorrhage, and two had grade 3 intraventricular hemorrhage. No epileptiform abnormalities were noted on any of the electroencephalograms. Despite this, the authors have speculated that the apneic events might represent subcortical or brainstem seizures and that primidone acted as an anticonvulsant. They have also pointed out that the action could be entirely different.
It is known that preterm infants without any perinatal or postnatal complications show apneic episodes accompanied by bradycardia that are particularly more frequent and severe during active or rapid eye movement sleep.2
Phenobarbital, which decreases the ratio of rapid eye movement