Sulthiame in childhood epilepsy

The indication for sulthiame, a carbonic anhydrase inhibitor, is benign childhood epilepsy with centro temporal spikes (BECTS). Up to now there is no systematic study of sulthiame in childhood epilepsy except BECTS.

We investigated the effect of sulthiame in childhood epilepsy in an open uncontrolled study in predominantly new diagnosed epilepsy during a period of two years. 93 children were enrolled, 52 boys, age 6.9±3.6 years; 41 girls, age 6.1±3.1 years with different epileptic syndromes. The mean sulthiame dose was 5.59±2.32mg/kg BW in boys and 5.35±2.44mg/kg BW in girls. Main side effects: hyperpnoe (7%), tiredness (3.2%), paresthesias (1.1%) without necessity for withdrawal.

Therapy results: 74. 2% became seizure free; 12. 9% had an increase of seizures; 9.7% had no effect on seizure frequency, 1.1% experienced a >50% seizure reduction or less severe seizure intensity. Syndrome specific: BECTS (n=27): 96.3 seizure free, 3.7% unchanged; focal motor (n=18): 68.4% seizure free, 15.8% no change, 10.5% increase; CPS (n=25): 64% seizure free, 4% reduction >50%, 12% unchanged, 20% increase; grand mal (n=13): 76.9% seizure free, 7.7%unchanged, 15.4%increase; Absence (n=1): seizure free; newborn seizure (n=1): unchanged; myoclonic (n=8): 25% seizure free, 25% unchanged, 50% increase; LGS (n=1): unchanged; CSWS (n=2): 100 seizure free. Effect of sulthiame on eeg: epileptic discharges absent – unchanged – increase: BECTS 70.4%/14.8%/14.8%; focal motor: 68.4%/15.8%/5.3%; CPS: 64%/16%/20%; myoclonic: 25%/25%/50%; absence: 100%; LGS: 0%/100%; newborn: 0%/100%; CSWS: 100%.

Summary: Sulthiame is not only effective in BECTS, but also in other epilepsy syndromes in childhood. In CPS, grand mal and focal motor seizures we achieved seizure control in 2/3 of all children. Sulthiame was well tolerated, the side effects were to ignorable in this study.