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Factors associated with behavioral and cognitive abnormalities in children receiving topiramate
P E Gerber1, L Hamiwka, M B Connolly
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Topiramate treatment in children can cause behavioral and cognitive abnormalities. A history of such issues and concurrent lamotrigine use may increase risk.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Topiramate is an anticonvulsant medication used to treat epilepsy and other conditions in children.
- Behavioral and cognitive side effects associated with topiramate therapy require further investigation in pediatric populations.
Purpose of the Study:
- To identify factors associated with behavioral and cognitive abnormalities in children treated with topiramate.
- To evaluate the relationship between topiramate dosage, rate of increase, and adverse neurodevelopmental outcomes.
Main Methods:
- Retrospective chart review of pediatric patients (up to 18 years) treated with topiramate at a tertiary epilepsy center.
- Analysis of demographic data, medication dosages, and documented behavioral or cognitive abnormalities.
Main Results:
- 14.6% of 75 children experienced behavioral or cognitive abnormalities within 2-4 months of starting topiramate.
- No significant difference in topiramate dosage or rate of increase was found between children with and without abnormalities.
- A history of prior behavioral/cognitive issues (P=0.03) and concurrent lamotrigine use (P=0.05) were associated with increased risk.
Conclusions:
- Behavioral and cognitive abnormalities in pediatric topiramate users are not linked to the rate of dosage escalation.
- Pre-existing behavioral problems and concomitant lamotrigine treatment may predispose children to these adverse effects.
Abstract:
The objective of this study was to examine the factors associated with the occurrence of behavioral and cognitive abnormalities in children treated with topiramate. A retrospective chart review of patients up to 18 years of age who had been treated with topiramate at a tertiary epilepsy center was performed. Behavioral or cognitive abnormalities were observed in 11 (14.6%) of 75 children between 2 weeks and 4 months after initiation of therapy. The mean dosage (4.6 mg/kg daily) at which these abnormalities were observed was similar to the mean final dose (5.8 mg/kg daily) in children without abnormalities. The mean rate of dosage increase was 0.72 mg/kg weekly and 0.7 mg/kg weekly in those with and without abnormalities, respectively. Five of the 11 children with behavioral or cognitive abnormalities had a previous history of behavioral or cognitive abnormalities, but only nine of the 64 children without abnormalities had a previous history of behavioral or cognitive abnormalities (P = 0.03). Lamotrigine was used concurrently in four of the 11 children with behavioral or cognitive abnormalities but in only seven of the 64 children without abnormalities (P = 0.05). Behavioral and cognitive abnormalities in children treated with topiramate do not appear to be related to the rate of dosage increase. A previous history of behavioral problems and the concurrent use of lamotrigine may be predisposing factors.