Abstracts

Rationale: Bromide is the oldest antiepileptic drug that nowadays is still but rarely used. Good improvement has been reported using bromide as treatment in Dravet syndrome, a highly pharmaco-resistant form of epilepsy. We analyzed effectiveness of bromide compared with other antiepileptic drugs in patients with Dravet syndrome and SCN1A-mutations.Methods: Retrospective analysis on the basis of patients histories and structured interviews of parents in 40 patients aged 2-25 years (mean age 12.1 years) with SCN1A-mutations. The patients suffered from typical Dravet syndrom or its borderline variants.Results: Antiepileptic drugs administered were azathioprine (AZA, n=2), bromide (BR, n=29), carbamazepine (CBZ, n=17), clobazam (CLB, n=25), ethosuximide (ESM, n=10), felbamate (FBM, n=6), gabapentin (GBP, n=1), lacosamid (LCM, n=2), lamotrigin (LTG, n=22), levetiracetam (LEV, n=23), mesuximid (MSM, n=8), oxcarbacepine (OXC, n=18), phenobarbital (PB, n=28), phenytoin (PHT, n=10), rufinamide (RFN, n=8), sulthiame (STM, n=15), stiripentol (STP, n=18), topiramate (TPM, n=31), vigabatrin (VGB, n=3), valproate (VPA, n=37) and zonisamide (ZNS, n=9). Patients had received an average of 9 different antiepileptic drugs (range: 3-18). At least temporary seizure reduction was achieved with BR (86%), CLB (84%), VPA (70%), STP (56%), TPM (55%), STM (53%), AZA (1/2), RUF (38%), ESM (30%), LTG (32%), LEV (30%), MSM (25%), FBM (17%), PB (11%), ZNS (11%), PHT (10%), CBZ (6%) and OXC (6%). Aggravation was observed with LCM (2/2), GBP (1/1), OXC (83%), CBZ (82%), ZNS (78%), PHT (70%), LTG (59%), AZA (1/2), VGB (1/3), TPM (23%), FBM (17%), LEV (13%), RUF (13%), STP (11%) and PB (4%). Aggravation was never observed with BR, CLB, ESM, MSM, STM and VPA.Conclusions: Bromide showed a clear effectiveness in patients with Dravet syndrome and SCN1A-mutations. Comparable results were observed with clobazam and to a somewhat lower degree with valproate, both first-line treatment in Dravet syndrom. We conclude that bromide holds promise in Dravet patients with SCN1A-mutations and intractable seizures.