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Prospective study of first-choice topiramate therapy in newly diagnosed infantile spasms
Li-Ping Zou1, Chang-Huan Ding, Fang Fang
1Department of Neurology, Beijing Children's Hospital, Capital University of Medical Sciences, Beijing, China. zouliping21@hotmail.com
Insights
Topiramate is an effective and safe first-choice treatment for infantile spasms in young children. This study found over half of patients remained seizure-free for 24 months with good tolerability.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Identifying effective first-line treatments is crucial for improving outcomes.
Purpose of the Study:
- To evaluate topiramate as a first-choice therapy for infantile spasms in children.
- Assessed efficacy, tolerability, and adverse events.
Main Methods:
- Prospective, open-label study of 54 infants with infantile spasms.
- Follow-up duration of 24–36 months.
- Topiramate used as initial treatment, alone or in combination.
Main Results:
- 57.4% of patients achieved seizure freedom for over 24 months.
- 81.4% experienced >30% reduction in seizure frequency.
- Adverse events (e.g., anorexia, sleeplessness) occurred in 26%.
Conclusions:
- Topiramate demonstrates efficacy and safety as a first-choice treatment for infantile spasms.
- It is effective in both monotherapy and adjunctive settings.
- Suitable for children under 2 years with infantile spasms.
Objective:
This was a prospective open study to establish the efficacy, tolerability, and problems associated with the use of topiramate as first-choice drug in children with infantile spasms.
Methods:
Open-label follow-up study, ranging from 24 to 36 months, of the cases of 54 patients with infantile spasms treated initially with topiramate as first-choice drug.
Results:
Thirty-one patients (57.4%) were seizure free for more than 24 months; 9 patients were treated with topiramate alone and 22 patients with topiramate plus nitrazepam and/or valproate. In 44 cases (81.4%), the reduction of seizure frequency from baseline was greater than 30%, whereas in 10 cases (18.6%), there was poor or no response. The average dosage applied was 5.2 mg/kg per day (maximum dosage, 26 mg/kg per day; minimum dosage, 1.56 mg/kg per day). Adverse events occurred in 14 patients (26%). They included poor appetite leading to anorexia, absence of sweating, and sleeplessness.
Conclusions:
Topiramate proves to be an effective and safe first-choice drug not only as adjunctive but also as monotherapy of infantile spasms in children younger than 2 years.
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