Efficacy and Safety of Topiramate in Refractory Epilepsy of Childhood

Abstract

This study aimed to evaluate the long-term efficacy and safety of topiramate in treating children with drug-resistant epilepsy. A multicentric, retrospective, open-label, add-on study was undertaken of 277 children (mean age 8.4 years; range 12 months to 16 years) affected by drug-resistant epilepsy. The efficacy was rated according to the seizure types and epilepsy syndrome. After a mean period of 27.5 months of treatment (range 24-61 months), 11 patients (4%) were seizure free and 56 (20%) had more than 50% reduction in seizure frequency. The efficacy of topiramate treatment was noted in localization-related epilepsy and in generalized epilepsy. In addition, in a group of 114 patients, we compared the initial efficacy (evaluated after a mean of 9 months of follow-up) and the retention at a mean of 30 months of topiramate with regard to loss of efficacy (defined as the return to the baseline seizure frequency). Fifty-five (48%) of 114 patients were initial responders. The retention at a mean of 30 months was 23 of 114 patients (20%), 4 of whom (3.5%) were still seizure free. A loss of efficacy occurred in 32 of the 55 initial responders (58%). It was prominent in patients with generalized epilepsy, such as symptomatic infantile spasms and Lennox-Gastaut syndrome, as well as in those with Dravet syndrome. By contrast, a well-sustained topiramate efficacy was noted among patients with localization-related epilepsy. Globally, adverse events were observed in 161 patients (58%) and were mainly represented by weight loss, hyperthermia, sedation, and nervousness, which, in most cases, disappeared after slowing titration or reducing the dosage of the drug. In conclusion, the present long-term study confirms that topiramate represents a useful drug effective in a wide range of seizures and epilepsy syndromes. Moreover, preliminary data seem to suggest that the efficacy of topiramate, when evaluated in the long-term perspective, is more sustained in localization-related epilepsy than in generalized epilepsy.

The Safety and Tolerability of Newer Antiepileptic Drugs in Children and Adolescents

“…[249,[251][252][253] Expressive language, attention, memory, processing speed, arithmetic and spatiotemporal skills may also be affected. [237,239,245] Language problems, more common in adults, include word-finding and speech fluency problems. [230,234] Risk factors for language problems may include simple partial seizures, a left temporal EEG epileptic focus and a history of cognitive problems.…”

“…[230][231][232][233][234][235][236][237][238][239][240][241][242][243][244][245][246][247] Psychomotor slowing and distal extremity paraesthesias are less common in children than in adults. [236,237,242,245] In addition to the above specific cognitive problems, generalized cognitive dysfunction is reported in 4-31% of children and adults.…”

Topiramate on the quality of life in childhood epilepsy

“…Topiramate (TPM) is a novel antiepileptic drug that has been used successfully, either as a single or an adjunctive therapy, to control both partial and generalized epileptic seizures in pediatric patients [10][11][12][13]. Few preliminary studies report favorable cognitive and/or QOL changes with TPM [14,15] but these effects have not been well documented in children.…”

Innovations in Epilepsy Management – An Overview

“…Bruni et al (33) assessed the efficacy of vigabatrin as add-on therapy in patients with refractory partial epilepsy and found that it was well tolerated by 7.2% of patients receiving the drug. Topiramate use is more sustained in localization related epilepsy than in generalized epilepsy (34). It can be used as adjunctive therapy in children, adolescents and young adults with Lennox Gastaut syndrome (35).…”