Chronic acetazolamide monotherapy controlled generalized tonic-clonic seizures in 14 of 31 patients with juvenile myoclonic-86-epilepsy treated in the Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, and the Department of Neurology, Stamford Hospital, Stamford, CT. The daily dose varied from 500 mg in six patients to 1750 mg in one (average 893 mg). Acetazolamide was less effective in controlling myoclonus than in the control of generalized tonic-clonic seizures. Six (43%) of 14 adults with generalized seizures responding to acetazolamide developed renal calculi. [1]

COMMENT. The frequency of renal calculus as a side effect of chronic acetazolamide therapy in the adults in this study is alarming and sufficient to contraindicate its use. In children, however, renal calculus is a rare side effect of acetazolamide, and this report in adults should not negate the efficacy and clinical use of acetazolamide in the treatment of childhood epilepsy.

In a double blind, placebo controlled trial of acetazolamide in 14 children, ages 6 months to 11 years, an anticonvulsant effect was demonstrated in all patients. Both generalized tonic-clonic and myoclonic seizures were reduced in frequency and in eight patients the maximal reduction in seizures was more than 75%. The control of generalized tonic-clonic seizures was superior to that of the myoclonic type. Acetazolamide monotherapy was used in two patients and additional antiepileptic drugs were continued in the remainder. Tolerance to the effect of acetazolamide shown in eight patients was a greater limiting factor than toxicity in this study. Polyuria and nocturnal enuresis were the only renal side effects and renal calculus did not occur [2]. Acetazolamide treatment of absence seizures reviewed in 620 children and young adults provided complete control in 50% and a 3/4 or greater reduction in an additional 26%. Side effects were reported in 60 (10%) patients and renal calculus occurred in one, a 20 year old adult. [3]