ACETAZOLAMIDE IN THE TREATMENT OF SEIZURES

OBJECTIVE: To summarize the pharmacology, pharmacokinetics, efficacy, and safety of acetazolamide and to evaluate its therapeutic role in pa tients with epilepsy. DATA SOURCES: A computerized search of the MEDLI NE (OVID) datal,ase (1966-1994) was used to identify publications rega rding acetazolamide. The MEDLINE search was supplemented by informatio n from textbooks. STUDY SELECTION: Included were English-language;revi ew articles, clinical trials, cohort studies, and case reports. Topics investigated included basic pharmacology, therapeutics, toxicology, a dverse reactions, dosage, administration, and pharmacokinetics of acet azolamide. DATA SYNTHESIS: Acetazolamide, a carbonic anhydrase inhibit or, has been approved for the treatment of epilepsy since 1953. Acetaz olamide is primarily used in combination therapy with other antiepilep tic medications in both children and adults although it may be used as monotherapy. Drug concentration monitoring has not been found to be r outinely beneficial. Adverse effects include kidney stones, metabolic acidosis, lethargy, appetite suppression, paresthesias, and rare blood dyscrasias. Partial tolerance may develop to the antiepileptic activi ty. CONCLUSIONS: Acetazolamide is a beneficial adjunctive agent in the pharmacotherapy of epilepsy and should be considered in refractory ep ilepsy. Although it may be useful in partial, myoclonic, absence, and primary generalized tonic-clonic seizures uncontrolled by other market ed agents, acetazolamide has been inadequately studied by current stan dards and its use has been limited.