title: Epilepsy of infancy with migrating focal seizures: six patients treated with bromide.
abstract: OBJECTIVE
  We present six patients with epilepsy of infancy with migrating focal seizures (EIMFS) and provide a comprehensive evaluation of potassium bromide therapy.
  
  
  METHODS
  Between February 1, 2007 and July 31, 2012, six patients who met the diagnostic criteria of EIMFS were treated with potassium bromide. Potassium bromide was added to other antiepileptic drugs (AEDs) in doses ranging from 30 to 80 mg/kg/day. Plasma bromide concentration was monitored. A therapeutic bromide concentration between 75 and 125 mg/dL was considered to be ideal.
  
  
  RESULTS
  Four of six children responded well to bromide. One of these patients became seizure free, but remained severely mentally impaired. Two boys, currently 4 and 6 years of age, respectively, have monthly seizures as well as axial hypotonia and severe language impairment. The fourth child responded well to bromide, having only weekly seizures and moderate psychomotor retardation. The patient who became seizure free improved visual contact and head control. In the other three patients with good control, the seizures became focal without secondary generalization and status epilepticus and hospital admission was not required. The remaining two patients did not respond well to bromide. Adverse effects were seen in three cases: vomiting in one, drowsiness in another, and acneiform eruption in the face in the remaining patient. Adverse effects resolved with dose reduction.
  
  
  CONCLUSIONS
  Early treatment with bromides should be considered in EIMFS to control the seizures and status epilepticus and to avoid progressive cognitive impairment. Potassium bromide is an old AED. Plasma concentration monitoring should be considered.
authors.affiliation: Neurology Department, Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina. Electronic address: rhcaraballo@arnet.com.ar.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caraballo
authors.affiliation: Neurology Department, Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
authors.forename: María Constanza
authors.initials: MC
authors.lastname: Pasteris
authors.affiliation: Neurology Department, Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
authors.forename: Pablo Sebastian
authors.initials: PS
authors.lastname: Fortini
authors.affiliation: Hospital Pediátrico Universitario de Centro Habana, La Habana, Cuba.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Portuondo
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000503:physiopathology*; D001965:Bromides / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D017680:Potassium Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D001965:Bromides; D017680:Potassium Compounds; C039004:potassium bromide
keywords: Epileptic encephalopathy; Focal seizures; Infants; Multifocal seizures; Potassium bromide; Refractory epilepsy