ABSTRACT
Bromide salts, introduced in the middle of the 19th century, were the first effective treatment for epilepsy. A standard pharmacology text no longer lists bromides as an antiepileptic agent, and earlier editions mention them as only having historical interest. The children who had failed other antiepileptic drugs (AEDs) had a similar success rate as children for whom bromides were the initial therapy. Bromides also potentiate the sedative effects of other agents at otherwise nontoxic doses. All of these problems are reversible, although the skin and gastrointestinal difficulties may preclude the further use of bromides. Patients with porphyria who have seizures present a special problem to the treating physician, as almost all of the standard AEDs can worsen the condition or initiate an acute episode. Bromides cross the placenta freely, and fetal levels closely parallel those of the mother. There are several reports of marked sedation and hypotonia at birth in babies whose mothers had become bromide-toxic.
