Is Ospolot (Sulthiame) Used for Rolandic Epilepsy in the US?

Ospolot (sulthiame) is used or recommended in some countries outside the United States as a treatment for Rolandic epilepsy (also called Self-limited epilepsy with centrotemporal spikes, or SeLECTS) ^[1]. However, it is not currently approved by the US Food and Drug Administration (FDA) ^[1][2]. This means it is not routinely marketed or stocked in US pharmacies. While clinicians can sometimes navigate complex expanded-access pathways, the lack of an established commercial supply makes it very difficult to obtain safely, and families should never purchase unregulated medication online.

If you are researching international treatments, it can be frustrating to find a medication that is unavailable locally. Fortunately, US pediatric epileptologists have deep experience managing SeLECTS using observation or other well-studied medications—such as levetiracetam or oxcarbazepine—that are commonly used for focal seizures ^[3].

Why is Sulthiame Used in Other Countries?

In regions where it is available, sulthiame is often considered because it reduces the distinctive electrical spikes seen on an electroencephalogram (EEG) (a test that measures brain waves) during sleep ^[4][5]. Short-term studies suggest sulthiame can reduce these abnormal brain waves without causing measurable negative impacts on a child’s cognitive performance ^[4].

However, the international evidence is not uniform. A major independent review of medical literature (the Cochrane review) concluded that the evidence comparing sulthiame to other medications is of “low certainty” ^[1]. While sulthiame is an option in some countries, large-scale data has not definitively proven that it is superior to US alternatives for stopping clinical seizures. Furthermore, reducing EEG spikes does not automatically guarantee seizure freedom or long-term protection of learning ^[1][6].

Standard US Approaches for Rolandic Epilepsy

Because SeLECTS is usually “self-limited”—meaning seizures often naturally remit by mid-adolescence ^[7]—treatment is highly individualized.

Observation Without Medication

If a child’s seizures are mild, infrequent, and happen only during sleep without impacting their daytime learning or behavior, doctors may recommend a “wait and see” approach ^[7]. However, “self-limited” does not mean the condition is always benign; significant changes in language, learning, or behavior warrant prompt medical evaluation ^[8][9].

Common US Medication Options

When medication is needed—due to frequent seizures, daytime seizures, or developmental concerns—US doctors typically consider the following options:

Levetiracetam (Keppra)

Levetiracetam is frequently used in the US to reduce both clinical seizures and abnormal sleep spikes on an EEG ^[4][10][6].

• Cognition and Behavior: While studies show it generally does not worsen a child’s visuospatial abilities (skills like judging distance and spatial relationships) ^[11], levetiracetam is known to cause behavioral side effects in some children, including irritability, aggression, or mood changes ^[4].
• Dosing: Some specific formulations of levetiracetam have been studied for once-nightly dosing to help with sleep and adherence ^[12]. However, dosing depends entirely on the specific formulation (immediate vs. extended-release), kidney function, and the child’s needs. Never change, combine, split, or stop doses without your prescriber’s explicit instructions, as abrupt changes can trigger seizures.

Oxcarbazepine (Trileptal)

Oxcarbazepine is another effective option for focal seizures ^[3].

• Side Effects: Common side effects include dizziness, sedation, nausea, and low blood sodium. Rarely, it can cause a severe skin rash.
• EEG Monitoring: In uncommon cases, oxcarbazepine has been associated with worsening the electrical brain activity during sleep, leading to a pattern sometimes called Electrical Status Epilepticus in Sleep (ESES) or DEE-SWAS ^[13]. This pattern can also emerge from the epilepsy itself. If your child suddenly struggles with learning, memory, or behavior, contact your neurologist promptly—they may order a sleep EEG to investigate ^[8][9].

Seizure Safety and Action Plan

Since nighttime seizures are common in SeLECTS, every family needs a basic safety plan:

• During a seizure: Keep the child safe by rolling them onto their side. Do NOT restrain them or put anything in their mouth.
• When to call emergency services: Call if a seizure lasts 5 minutes or longer, if repeated seizures occur without the child waking up in between, if they have difficulty breathing, or if they are injured.
• Ask your doctor if your child needs a specific “rescue medication” for prolonged seizures, as well as basic bathing and water safety precautions.

Medication Comparison Summary