Effect of sulthiame on EEG pathology, behavior and school performance in children with Rolandic epileptiform discharges

Background:  Rolandic epileptiform discharges (RED) may be associated with behavioral difficulties and low school performance. The aim of this study was to assess whether sulthiame is effective in improving electroencephalogram (EEG) pathology, and whether these changes are paralleled by improved school performance and behavior. Methods:  In this single-center study at a university hospital, 38 children with RED (27 boys, 11 girls; mean age, 6 years; range, 3–11 years), but no overt seizures, were included. Sixteen of them were treated with sulthiame (3–10 mg/kg). The observational period was 12 months. In both groups serial EEG was performed, and school performance and behavioral skills were assessed by parents and teachers. Results:  Children treated with sulthiame showed marked improvement on EEG pathology when compared to the non-treated group (75% vs 44%; P= 0.149). Improvement of EEG pathology was significantly associated with better school performance and normalization of behavioral difficulties (P= 0.016). A significant positive correlation was established between sulthiame treatment and improved intellectual/school performance and behavior (P < 0.05). Side-effects (transient episodes of tachypnea) were rare (four children; 25%). Conclusion:  EEG pathology can be improved with sulthiame in children with RED. The EEG changes were associated with improved clinical outcome parameters. The present findings need to be confirmed in a larger randomized controlled trial.