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Clinical experiences with topiramate in children with intractable epilepsy
1Dianalund Epilepsy Hospital, Denmark.
Insights
Topiramate (TPM) shows promise as a broad-spectrum anti-epileptic drug for children with intractable epilepsy. This add-on therapy demonstrated seizure reduction and improved general condition in many participants, even those resistant to other treatments.
Area of Science:
- Neurology
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Intractable epilepsy in children presents significant treatment challenges.
- Many pediatric epilepsy syndromes are resistant to existing anti-epileptic drugs.
- Topiramate (TPM) is a broad-spectrum anti-epileptic drug with potential utility in refractory cases.
Purpose of the Study:
- To evaluate the efficacy and tolerability of topiramate (TPM) as an add-on therapy in children with intractable epilepsy.
- To assess seizure frequency reduction and general condition improvement in pediatric patients treated with TPM.
- To determine the safety profile and optimal dosing of TPM in a pediatric population.
Main Methods:
- An open add-on study enrolled 39 children with intractable epilepsy at a tertiary referral center.
- Patients received topiramate (TPM) with slow titration to an estimated target dose.
- Follow-up assessments included seizure frequency, general condition, and adverse events over a mean of 13 months.
Main Results:
- Nineteen children continued TPM treatment, with 8% seizure-free and 21% experiencing >50% seizure reduction.
- Eight children (21%) showed improvement in general condition.
- Adverse effects, primarily weight loss and sedation, were reported in 54% of cases.
Conclusions:
- Topiramate (TPM) appears to be a promising broad-spectrum anti-epileptic drug for pediatric intractable epilepsy.
- TPM demonstrated efficacy in epilepsy syndromes refractory to other novel anti-epileptic drugs.
- Further investigation into TPM's long-term efficacy and safety in children is warranted.
Abstract:
At a tertial referral epilepsy centre 39 children were consecutively enrolled in an open add-on study with topiramate (TPM). All children had intractable epilepsy; the mean seizure frequency was 36 per month, and 31 children were treated with polypharmacy. All but five children were mentally retarded. The initial dose of TPM was 0.5-1 mg/kg daily, slowly titrated with 1-3 mg/kg daily every second week with an estimated target dose of 10 mg/kg daily. At latest follow-up 19 children continued on TPM, three (8%) were seizure-free, eight (21%) had a seizure reduction of more than 50% and eight (21%) improved their general condition. Mean follow-up was 13 months (range 9-36 months). Seizure reduction was seen in focal as well as generalized epilepsies. Adverse effects were reported in 21 cases (54%), weight loss and sedation being most frequent. The mean steady state dose in the children continuing on TPM was at latest follow-up: 14 mg/kg daily (< 5 years), 10 mg/kg daily (5-7 years), 5.8 mg/kg daily (8-17 years). The corresponding plasma level varied from 3 to 45 mumol/litre, and a significant correlation between the daily dose in mg/kg and the plasma level was found. Two patients with progressive myoclonus epilepsy are described separately; one had a dramatic general improvement. It is concluded that TPM seems to be a promising new broad-spectrum anti-epileptic drug, which is efficacious even in epilepsy syndromes, intractable to other new anti-epileptic drugs such as vigabatrin and lamotrigine.