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[Course of drug-resistant childhood epilepsy treated with topiramate]
J M Prats Viñas1, C Garaizar Axpe, M J Martínez González
1Unidad de Neuropediatría; Hospital de Cruces, Baracaldo, 48903, España. jprats@hcru.osakidetza.net
Insights
Topiramate as add-on therapy showed partial seizure control in 52% of children with difficult-to-treat epilepsy. Long-term follow-up demonstrated sustained efficacy, with 25% achieving partial control at 18 months.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Childhood epilepsy presents a significant challenge, with a notable proportion of cases exhibiting resistance to conventional treatments.
- The development of novel antiepileptic drugs is crucial for managing treatment-resistant epilepsy in children.
Purpose of the Study:
- To evaluate the effectiveness of topiramate as an adjunctive therapy in a pediatric neurology clinic setting.
- To assess the real-world efficacy and duration of topiramate treatment for childhood epilepsy.
Main Methods:
- A retrospective analysis was conducted on pediatric patients receiving topiramate as add-on therapy.
- Seizure frequency reduction (≥50% partial control) and total seizure control were primary outcome measures.
- Kaplan-Meier method was used to analyze treatment duration and maintenance.
Main Results:
- 31 treatment courses in 29 children were analyzed, with epilepsy etiologies including idiopathic, cryptogenic, and symptomatic forms.
- After 3 months, 52% of patients achieved ≥50% seizure reduction, with 25% maintaining this response at 18 months.
- Complete seizure control was achieved in 18.5% at 3 months, maintained by 12.5% at 12 months. Treatment discontinuation occurred in 29% of patients.
Conclusions:
- Topiramate demonstrates efficacy as add-on therapy for difficult-to-treat childhood epilepsy, offering partial and total seizure control.
- The observed responses are comparable to those of established antiepileptic drugs.
- Treatment outcomes are influenced by the duration of follow-up, highlighting the importance of long-term monitoring.
Introduction:
The variable proportion of cases with childhood epilepsy resistant to treatment, has led to the development of different new drugs.
Objective:
To study the efficacy of topiramate as add-on therapy in the everyday practice of a neuropaediatric clinic.
Patients And Methods:
A retrospective study of all the patients treated with topiramate in a hospital outpatient clinic was performed.
Outcome Measurement:
1. Reduction in >/= 50% as compared to basal frequency (partial control) and total control of seizures, and 2. Duration of drug treatment, using the Kaplan-Meier method.
Results:
We studied 31 courses of treatment in 29 children. The aetiology of the epileptic syndromes was: idiopathic epilepsy (3.3%), cryptogenic epilepsy (58%) and symptomatic epilepsy (38.7%). We found a >/= 50% reduction in the basal monthly frequency of seizures after 3 months of treatment in 52% of the patients, which persisted 18 months later in 25%. Total control of seizures was obtained in 18.5% of the patients after 3 months of treatment, and this response was maintained 12 months later in 12.5%. The probability of maintaining treatment with topiramate for 6 months was 80%, and for 12 months was 49%. The average duration of treatment was 7.9 months (interval 1-29 months). Topiramate was suspended in 9 patients (29%).
Conclusion:
In difficult to treat childhood epilepsy topiramate as add-on therapy provides a partial and total responses which are similar to those reported with classical drugs, and depend on the duration of follow-up.