SULTHIAME AND BEHAVIOUR

SULTHIAME (‘Ospolot’) has been in use for over 12 years, primarily as an anticonvulsant. In 1962, at an international symposium near Cologne, various authors reported results in over 600 patients1. The type of epilepsy and the criteria for giving sulthiame and for evaluation of results varied considerably between different authors, but in general terms 22 per cent of 600 patients were rendered seizure free and a further 28 per cent had their seizures reduced by half or more. Subsequent reports from the United Kingdom were more variable. SMYTH~ treated 46 out-patients of average or superior intelligence who had temporal lobe epilepsy. He used 600mg of sulthiame as a maximum daily dose. Thirty-five (76 per cent) of these patients had a 75 per cent reduction in seizure frequency or a period of freedom from seizures four times longer than any previous period. INGRAM and RATCLIFFE3 found the drug to be particularly effective in myoclonic and focal seizures but reported a high incidence of side-effects (59 per cent). On the other hand, GORDON4 reported a much lower success rate in 50 patients: four per cent had abolition of seizures, 20 per cent showed a reduction in frequency of more than one half, and 60 per cent showed no significant change. A few early reports on sulthiame indicated a beneficial effect on certain aspects of behaviour. STUTTE et aL5, after treating 50 patients from two to 18 years of age suffering from a variety of the epilepsies, reported on a number of factors including the return to normal of ‘epileptic’ personality changes, improvement in the power of concentration and perseverance, increase in motivation, and equilibriation of mood. No figures are quoted concerning the degree of improvement or in how many patients it is alleged to have occurred. At the symposium in 1962, HAJNSEK and SARTORIUS~ reported an improvement in the ‘psychic condition’ in 49 of 100 patients, but their criteria are not defined in any meaningful way. Another early report concerning the effect of sulthiame on behaviour was that of HARAN’. 48 patients with epilepsy were entered into this uncontrolled trial. HARAN pointed out that “the majority had reached a state of mental deterioration in which differential diagnostic criteria were blurred. It was not possible to put them in any definite category . . .”. Improvement was judged entirely from the opinions of nursing and medical staff using three categories of much improved, improved, and no change, and was applied to both seizure control and behaviour or personality. Of the 40 patients finally analysed, seven (17-5 per cent) were said to be much improved, 12 (30 per cent) were improved and 21 (52.5 per cent) showed no change. The author concluded firstly that sulthiame was an efficient anticonvulsant, and secondly that there was a specific effect on the emotional, personality and behaviour disorders associated with epilepsy, manifest by a reduction in irritability and aggression, improved psychomotor co-ordination and decreased viscosity of thought and body. (The abstract provided by Bayer Pharmaceuticals states that there was increased viscosity of thought.) The conclusions are difficult to evaluate as no figures of seizure