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Low-dose topiramate is effective in the treatment of infantile spasms
Meng-Ying Hsieh1, Kuang-Lin Lin, Huei-Shyong Wang
1Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University Medical Collage, Taoyuan, Taiwan, ROC.
Insights
Topiramate (TPM) effectively controlled infantile spasms in children, with many achieving seizure reduction or freedom at lower doses than previously reported. This study determined the optimal TPM dosage for infantile spasms management.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Infantile spasms (IS) present a significant management challenge due to the limited efficacy of current treatments.
- Anticonvulsants and hormonal therapies often fail to provide adequate seizure control in IS patients.
Purpose of the Study:
- To ascertain the effective dosage of topiramate (TPM) for treating infantile spasms in a Taiwanese pediatric population.
- To evaluate the efficacy and optimal dosing of topiramate in children diagnosed with infantile spasms.
Main Methods:
- A cohort of 14 Taiwanese children diagnosed with infantile spasms participated in the study.
- Topiramate (TPM) was administered at an initial dose of 12.5 mg/day, with dose titration guided by seizure frequency and patient response over up to 12 weeks.
- Weekly monitoring ensured dose adjustments and assessment of treatment efficacy.
Main Results:
- Overall, 38% (5/13) of patients achieved complete seizure control, and 85% (11/13) experienced a reduction of at least 50% in spasm frequency.
- The mean topiramate (TPM) dose during stabilization was 7.35 +/- 4.9 mg/kg/day.
- Notably, 6 patients achieved seizure control, and 3 became seizure-free at TPM doses below 6 mg/kg/day.
Conclusions:
- Topiramate (TPM) therapy demonstrated efficacy in managing infantile spasms, achieving seizure control at doses lower than those previously documented.
- The findings suggest that lower topiramate dosages may be sufficient for effective infantile spasms treatment in children.
Background:
Management of infantile spasms is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. We conducted this study to determine the effective dose of topiramate (TPM) in Taiwanese children with infantile spasms.
Methods:
Fourteen patients with infantile spasms were given TPM at an initial dose of 12.5 mg/d, and the dose was raised by 12.5 mg every 2 approximately 3 days. If the seizure frequency did not decrease during the initial 2 weeks, the dose was raised more rapidly. Titration continued for < or = 12 weeks. Subjects were monitored by weekly visits to undergo titration.
Results:
The etiology of the infantile spasms included a cryptogenic group (n = 3) and a symptomatic group (n = 11). Overall, spasms in 5 patients (38%) were completely controlled. A > or = 50% reduction in spasms was observed in 11 (85%) of 13 subjects during stabilization, while one patient quit the treatment. The mean dose of TPM during stabilization was 7.35 +/- 4.9 mg/kg/d. Among these, 6 patients achieved seizure control and 3 were free of seizures at TPM doses of lower than 6 mg/kg/d.
Conclusions:
Seizure control was achieved with lower doses of TPM therapy than suggested in previous studies.
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