Related Experiment Videos
Concomitant treatment with topiramate and ketogenic diet in pediatric epilepsy
Masanori Takeoka1, James J Riviello, Heidi Pfeifer
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital, Boston, Massachusetts, USA. maxtakeoka@aol.com
Insights
In children with epilepsy, combining topiramate (TPM) and ketogenic diet (KGD) therapy may cause metabolic acidosis. Monitoring bicarbonate levels and providing supplements when needed is crucial for safe cotreatment.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Topiramate (TPM) is an antiepileptic drug that inhibits carbonic anhydrase, potentially causing metabolic acidosis.
- The ketogenic diet (KGD) also predisposes patients to metabolic acidosis, particularly during its initiation phase.
- Combined use of TPM and KGD in refractory epilepsy requires careful consideration of risks like metabolic acidosis and nephrolithiasis.
Purpose of the Study:
- To evaluate the safety and effects of combined topiramate (TPM) and ketogenic diet (KGD) therapy in children with refractory epilepsy.
- To assess the incidence of metabolic acidosis and nephrolithiasis in this pediatric patient group.
Main Methods:
- Retrospective review of medical records for 14 children with refractory epilepsy treated with KGD and TPM.
- Analysis of serum bicarbonate levels, correlated with treatment duration, TPM dosage, KGD ratio, and seizure control.
Main Results:
- A decrease in bicarbonate levels (<20%) was observed in nine children, with a mean decrease of 7.6 mEq/L.
- Cotreatment was sustained for 33 to 544 days, with two children requiring bicarbonate supplementation.
- No instances of nephrolithiasis were reported in any of the patients.
Conclusions:
- The majority of children experienced a decrease in bicarbonate levels, primarily during KGD induction when added to existing TPM therapy.
- Close monitoring of bicarbonate levels is essential during combined TPM and KGD treatment.
- Symptomatic patients may benefit from bicarbonate supplementation to manage acidosis.
Purpose:
Topiramate (TPM) is widely used as add-on therapy for epilepsy. TPM inhibits carbonic anhydrase, which may result in metabolic acidosis from decreased serum bicarbonate. The ketogenic diet (KGD) predisposes patients to metabolic acidosis, especially during induction. In children with refractory epilepsy, cotreatment with TPM and KGD may be considered, but special attention should be paid to the combined risks for metabolic acidosis and nephrolithiasis. We report our experience in 14 children cotreated with TPM and the KGD.
Methods:
Medical records of 14 children cotreated with the KGD and TPM for medically refractory epilepsy were reviewed retrospectively. Bicarbonate levels were analyzed and correlated with clinical profiles, including duration of cotreatment, TPM dose, KGD ratio, and seizure control.
Results:
Nine children had a <20% decrease in bicarbonate levels, from 5.3 to 12.3 mEq/L (mean, 7.6 mEq/L). Cotreatment was continued in all patients for duration of 33 to 544 days (seven had remained on cotreatment at the end of the study period), although two children required bicarbonate supplements to continue the KGD. No patient had nephrolithiasis.
Conclusions:
Although a large decrease in bicarbonate level occurred in the majority of children, the decrease appeared mostly at the time of KGD induction when added to prior TPM therapy. Bicarbonate levels should be monitored carefully with TPM and KGD cotreatment, and bicarbonate supplements given when symptomatic.