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Bromide therapy for pediatric seizure disorder intractable to other antiepileptic drugs
1Department of Pediatrics, University of Maryland, School of Medicine, Baltimore 21201.
Insights
Triple bromide elixir effectively treated intractable epilepsy in 11 children. This adjunctive antiepileptic drug therapy showed minimal toxicity and significant seizure control, especially when combined with valproate.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Epilepsy is a chronic neurological disorder characterized by recurrent seizures.
- Intractable epilepsy poses significant challenges in pediatric patient management.
- Limited effective adjunctive therapies exist for refractory pediatric epilepsy.
Purpose of the Study:
- To evaluate the efficacy and safety of triple bromide elixir as an adjunctive antiepileptic drug.
- To assess bromide therapy in children with seizure disorders resistant to conventional treatments.
Main Methods:
- A cohort of 11 pediatric patients (ages 2-17) with intractable epilepsy received triple bromide elixir.
- Treatment outcomes, including seizure frequency and adverse events, were monitored.
- Therapeutic doses and serum bromide concentrations were analyzed in patients with seizure control.
Main Results:
- Two patients achieved complete seizure cessation; four experienced significant sustained improvement.
- Four patients had transient improvement; minimal toxicity was observed, with only one discontinuation due to anorexia.
- Optimal therapeutic range: 33 mg bromide/kg/day, serum concentration 14.1 mmol/L (4-30.5 mmol/L).
- Combination therapy with valproate showed particular effectiveness.
Conclusions:
- Triple bromide elixir is a viable, low-cost adjunctive therapy for intractable pediatric epilepsy.
- Monitoring serum bromide concentrations ensures minimal toxicity and optimal therapeutic outcomes.
- Bromide therapy offers a valuable option for refractory seizure disorders in children.
Abstract:
Triple bromide elixir was used as an adjunctive antiepileptic drug in 11 children whose seizure disorders were intractable to other antiepileptic therapy. The patients' ages ranged from 2 to 17 years. The seizure disorders treated included photosensitive epilepsy (one case), acquired epileptic aphasia (one case), Lennox-Gastaut syndrome (three cases), and symptomatic localization-related epilepsies (six cases). Two patients' seizures completely stopped with bromide therapy. Four patients had a significant and sustained improvement on bromide therapy, while three more had a transient improvement. In these six patients with complete or significant control, the mean therapeutic dose was 33 mg bromide/kg daily, and the mean therapeutic serum concentration was 14.1 mmol/L (range, 4 to 30.5 mmol/L). The combination of bromide with valproate appeared to be particularly effective in these patients. Toxicity was minimal, and in only one patient was the medication stopped, because of anorexia and weight loss. Given the low cost, long half-life, and minimal toxicity when serum bromide concentrations are followed, bromide therapy should be considered as adjunctive antiepileptic drug therapy for patients whose seizures are intractable to other drugs.