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Topiramate for drug-resistant partial epilepsy.
N J Jette1, A G Marson, Z A Kadir
1Department of Neurology, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Canada, K1H 8L6. n.jette@sympatico.ca.
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Topiramate demonstrates efficacy as an add-on treatment for drug-resistant partial epilepsy, significantly reducing seizure frequency. However, long-term effectiveness and safety in various epilepsy types require further investigation.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Refractory epilepsy affects up to 30% of patients, particularly those with partial seizures.
- Topiramate is a newer antiepileptic drug evaluated for this patient group.
Purpose of the Study:
- To assess the efficacy and tolerability of topiramate as an add-on therapy.
- To analyze its effectiveness in drug-resistant partial epilepsy.
Main Methods:
- Systematic review of randomized placebo-controlled add-on trials.
- Inclusion of data from The Cochrane Library, trial registers, and industry sources.
- Assessment of seizure reduction, treatment withdrawal, and side effects using intention-to-treat analysis.
Main Results:
- Six trials involving 743 patients were analyzed.
- Topiramate significantly increased the likelihood of a 50% or greater seizure reduction (OR 4.06).
- Increased dosage correlated with efficacy up to 400 mg/day; common side effects included dizziness, fatigue, nausea, somnolence, and cognitive disturbances.
Conclusions:
- Topiramate is effective as an add-on treatment for drug-resistant partial epilepsy.
- Short trial durations limit conclusions on long-term efficacy.
- Results are not generalizable to monotherapy or other epilepsy types.