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Potassium bromide for treatment of malignant migrating partial seizures in infancy

BACKGROUND

The syndrome of malignant migrating partial seizures in infancy is a rare epileptic syndrome with a devastating course characterized by early onset of continuous pharmacoresistent multifocal seizures arising from multiple independent sites of both hemispheres with unknown etiology.

PATIENT

A 2-month-old boy with the characteristic clinical and electroencephalograph pattern of migrating partial seizures in infancy was treated with potassium bromide. His seizures were unresponsive to the conventional and new generation antiepileptic drugs.

RESULTS

The seizure frequency was reduced markedly with potassium bromide.

CONCLUSIONS

Potassium bromide, an old antiepileptic drug, is useful in the treatment of malignant migrating partial seizures in infancy.

Pharmacology, efficacy, and tolerability of potassium bromide in childhood epilepsy

This study investigated the efficacy and tolerability of potassium bromide in 113 patients (aged, 1-20 years) with severe epilepsy and generalized tonic-clonic seizures. Potassium bromide was started at 45 mg/kg and raised to 70 mg/kg (median). Steady-state blood level was reached after a median of 28 days (range, 5-95 days). The number of patients who had suffered generalized tonic-clonic seizures during the last month dropped from 82 to 41, and the median frequency, dropped from 4.5 to 0 per month. Of the patients with generalized tonic-clonic seizures during baseline, 49% showed none in the last 4 weeks of the study, and another 31% showed a reduction by more than 50%. Potassium bromide should have a place as a drug of tertiary choice in the treatment of children with epilepsy. Experience with the drug and close clinical and pharmacologic monitoring are necessary to achieve the greatest possible benefit and avoid side effects.