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Topiramate add-on for drug-resistant partial epilepsy
Nathalie Jette1, Karla Hemming, Jane L Hutton
1Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, 1403-29 Street NW, Calgary, Alberta, Canada, TN2 2T9. nathalie.jette@calgaryhealthregion.ca
The Cochrane Database of Systematic Reviews
|July 23, 2008
Summary
Topiramate effectively reduces seizure frequency in drug-resistant partial epilepsy as an add-on therapy. However, short trial durations limit conclusions on long-term efficacy and side effects.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Epilepsy affects many, with most responding to single antiepileptic drugs.
- Up to 30% of patients develop drug-resistant epilepsy, particularly those with partial onset seizures.
- Topiramate is a newer antiepileptic drug evaluated for this patient group.
Purpose of the Study:
- To assess the efficacy of topiramate as an add-on treatment for drug-resistant partial epilepsy.
- To evaluate the safety and side effect profile of topiramate in this context.
Main Methods:
- Systematic review of randomized placebo-controlled add-on trials.
- Searched Cochrane Epilepsy Group Specialized Register and CENTRAL.
- Assessed seizure frequency reduction, treatment withdrawal, and side effects.
Main Results:
- Ten trials with 1312 participants showed topiramate significantly increased 50% seizure reduction (RR 2.85).
- Higher doses (over 300-400 mg) showed no additional benefit.
- Increased risk of side effects including ataxia, dizziness, fatigue, nausea, somnolence, and cognitive disturbances.
Conclusions:
- Topiramate demonstrates efficacy for drug-resistant partial epilepsy as add-on therapy.
- Short trial durations preclude assessment of long-term efficacy.
- Results are not generalizable to monotherapy or other epilepsy types.
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