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Topiramate in refractory epilepsy: a prospective observational study
L J Stephen1, G J Sills, M J Brodie
1University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, Scotland.
Epilepsia
|August 29, 2000
Summary
Topiramate (TPM) effectively treated refractory epilepsy in a real-world setting, with many patients achieving seizure freedom or reduction at lower doses. Tolerability varied, with common side effects leading to discontinuation in some cases.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Refractory epilepsy presents significant treatment challenges.
- Identifying effective antiepileptic drugs for diverse patient populations is crucial.
Purpose of the Study:
- To evaluate the efficacy and tolerability of topiramate (TPM) as an adjunctive therapy in patients with refractory epilepsy.
- To assess TPM's effectiveness in a routine clinical outpatient setting.
Main Methods:
- A prospective observational study involving 170 patients with refractory epilepsy.
- Patients received adjunctive topiramate with a standard titration schedule.
- Outcomes included seizure freedom, seizure reduction, or drug discontinuation.
Main Results:
- 23% of patients achieved seizure freedom, and 47% experienced a significant seizure reduction.
- Effective responses were observed with lower topiramate doses (≤100 mg/day) in some patients.
- Discontinuation due to side effects occurred in 30% of patients, with fatigue and weight loss being common.
Conclusions:
- Topiramate demonstrates efficacy as both add-on and monotherapy for refractory partial and generalized seizures in clinical practice.
- Lower doses of topiramate may be effective, suggesting personalized treatment approaches.
- Variability in dose-response and toxicity highlights the complexity of refractory epilepsy management.