Bromide shows promise against SCN1A-associated Dravet syndrome with intractable seizures

In the mid-nineteenth century Charles Locock, physician to Queen Victoria, introduced bromide as the first effective treatment for epilepsy. The drug was little used in treating the disorder until 1868, however, when its efficacy against seizures was first demonstrated in a clinical trial. Bromide was the sole anticonvulsant available until 1912 and the introduction of phenobarbital.

Bromide is not FDA-approved for use in the United States. But it is among anticonvulsants available in Germany and other European countries. Research reported today at the American Epilepsy Society's 65th annual meeting by investigators from Germany suggests that bromide may have promise in treating patients with SCN1A-associated Dravet syndrome with intractable seizures.

Jan Lotte and colleagues at the Schön Klinik in Vogtareuth, Germany, conducted a retrospective analysis of patient medical histories and structured parent interviews on a cohort of Dravet patients 2 to 25 years of age with SCN1A mutations. A total of twenty-one anticonvulsant drugs, including bromide, were found in the analysis. Most of the anticonvulsants provided at least some degree of seizure control. The investigators also found that fifteen of the twenty-one drugs were associated with an aggravation of the condition. Aggravation was not observed with six of the medications, including bromide.

"Bromide showed a clear effectiveness in patients with Dravet syndrome and SCN1A mutations," says Lotte. "Treatment with this medication achieved results comparable to clobazam and clearly above valproate, both first-line therapies for Dravet syndrome. We think that bromide may have a particular role in treating Dravet patients with SCN1A mutations with intractable seizures."

Bromide builds up slowly in the bloodstream taking time to achieve therapeutic levels. Usually the drug is well tolerated, significant toxic side effects are seldom to be found.