[Effects of topiramate on headache in children with epilepsy]
Insights
Topiramate (TPM) effectively reduced inter-ictal headaches in children with epilepsy, with 72% responding to treatment. Lower doses of TPM were effective for headache management compared to seizure control.
Area of Science:
- Pediatric Neurology
- Epileptology
- Headache Medicine
Background:
- Headache is a common comorbidity in children with epilepsy.
- Inter-ictal headaches can significantly impact quality of life in pediatric epilepsy patients.
- Limited treatment options exist for managing headaches in this population.
Purpose of the Study:
- To evaluate the efficacy and safety of topiramate (TPM) for treating inter-ictal headaches in children with epilepsy.
- To determine the optimal dosage of TPM for headache relief in this patient group.
Main Methods:
- A study involving 85 pediatric outpatients (ages 5-15) with epilepsy.
- Patients were assessed for inter-ictal headaches, defined as headaches occurring outside of seizure activity.
- Topiramate (TPM) was administered at doses ranging from 0.5 to 3.0 mg/kg/day.
Main Results:
- 18.2% of patients reported inter-ictal headaches, with higher seizure frequency noted in those with headaches.
- Topiramate (TPM) demonstrated a 72% responder rate (over 50% reduction in headache frequency/severity).
- Six children (33.3%) achieved complete headache cessation; responders required significantly lower TPM doses.
Conclusions:
- Inter-ictal headaches are more prevalent in children with frequent seizures.
- Topiramate (TPM) is a valuable therapeutic option for managing headaches in children with epilepsy.
- Effective doses of TPM for headache may be lower than those used for seizure control.
Objectives:
The purpose of the present study was to evaluate the efficacy and safety of topiramate (TPM) on inter-ictal headache in children with epilepsy.
Methods:
Patients were interviewed regarding whether they suffered from headaches. Data obtained from each patient included seizure frequency. Inter-ictal headache was defined as a headache beginning outside an hour before or after the seizure. The study group included 85 outpatients (42 valproate-treated, 34 carbamazepine-treated, 6 combination therapy, 3 other) between 5 and 15 years old. For children with headache, TPM was administered twice daily at a total initial dose of 0.5 mg/kg/day, up to 3.0 mg/kg/day in accordance with symptoms.
Results:
Of 85 patients, 18 (21.2%) patients (8 valproate-treated, 6 carbamazepine-treated, 3 combination therapy, and 1 other) complained of inter-ictal headache. Seizure frequency was significantly higher in children with headache (2.6 times/year) than in children without headache (0.9 times/year; p < 0.0001). The responder rate (rate of patients with a > 50% reduction in headache frequency or degree) was 13/18 (72%). Six children (33.3%) achieved complete cessation for the entire 6 months. Mean dose of TPM was significantly lower in responders (1.1 mg/kg/day) than in non-responders (2.7 mg/kg/day; p < 0.001).
Conclusions:
Headache is encountered more frequently in patients with frequent seizures. In addition, TPM represents a useful addition to the treatments available for headache in children with epilepsy. The effective dose of TPM for headache may be lower than that for seizure.
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