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Acetazolamide: Old drug, new evidence?
Arif Ali Shukralla1, Emma Dolan1, Norman Delanty1,2,3
1The National Epilepsy Programme, Beaumont Hospital, Dublin, Ireland.
Epilepsia Open
|June 8, 2022
Summary
Acetazolamide, an antiepileptic drug, shows potential seizure reduction but requires further study. Observational data suggests efficacy, yet its limited use stems from concerns about side effects and effectiveness, necessitating randomized trials.
Area of Science:
- Neuroscience
- Pharmacology
Background:
- Acetazolamide is an established antiepileptic agent with limited current use.
- Perceived poor efficacy and adverse events contribute to its underutilization.
Purpose of the Study:
- To review the evidence for acetazolamide's efficacy as an antiepileptic agent.
- To explore potential mechanisms of action and assess clinical outcomes from observational studies.
Main Methods:
- Analysis of 12 observational studies involving 941 patients treated with acetazolamide.
- Review of proposed mechanisms including carbonic anhydrase inhibition, acid-sensing ion channels, neuroinflammation, and network oscillations.
Main Results:
- A 50% responder rate of 49% was observed.
- 20% of patients achieved seizure freedom.
- 30% of patients experienced at least one adverse event.
Conclusions:
- Observational studies may overestimate acetazolamide's efficacy due to the lack of comparators.
- Further randomized placebo-controlled trials are essential to accurately determine its effectiveness and safety profile.
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