The use of methsuximide in 25 children with intractable epilepsy is reported from the Department of Neurology and School of Pharmacy, University of North Carolina, Chapel Hill. In 15 patients methsuximide was well tolerated and resulted in a 50% or greater reduction in seizure frequency. The predominant seizure types were tonic, complex partial, secondary generalized and astatic/myoclonic. The EEG showed generalized slow spike and wave in 14 and focal spikes in three. Two developed hypersensitivity rashes, two had intractable hiccups and four reported nausea. Patients had failed therapy with phenobarbital, primidone, phenytoin, carbamazepine and valproic acid alone or in various combinations. Decreases in carbamazepine serum concentrations occurred after starting methsuximide as an adjunctive anti-epileptic. 
COMMENT. Methsuximide has been reported of benefit in the treatment of petit mal, partial myoclonic, atonic and tonic seizures. As monotherapy methsuximide is not well established, but as an adjunct therapy further trials should be considered. Skin rash is not uncommon and methsuximide may be contraindicated in patients with a history of hypersensitivity reactions to other anticonvulsants.