Topiramate for Seizures in Preterm Infants and the Development of Necrotizing Enterocolitis

Courchia, Benjamin; Kurtom, Waleed; Pensirikul, Alyssa; Del-Moral, Teresa; Buch, Maria

doi:10.1542/peds.2017-3971

Cited by 13 publications

(7 citation statements)

References 12 publications

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Section: Resultsmentioning

confidence: 99%

“…88 Although limited anecdotal data suggest benefit in preterm infants (maintenance doses of 3.5-8 mg/kg/d), 89 this ASM is not without potential serious adverse effects in these patients, including irritability, feeding problems, metabolic acidosis, and, more recently, necrotizing enterocolitis. 90 In adults, although several small retrospective reviews and/or case series have evaluated topiramate in RSE, evidence is sparse for SRSE. 91 For the treatment of RSE, data have been conflicting, with Hottinger and colleagues reporting in a retrospective study that topiramate successfully terminated RSE in over 70% of patients when topiramate was given as the fourth to seventh ASM at doses ranging from less than 400 to 799 mg/d.…”

Section: Topiramatementioning

confidence: 99%

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Treatment of Super-Refractory Status Epilepticus: A Review

et al. 2021

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Purpose: Super-refractory status epilepticus (SRSE) presents management challenges due to the absence of randomized controlled trials and a plethora of potential medical therapies. The literature on treatment options for SRSE reports variable success and quality of evidence. This review is a sequel to the 2020 American Epilepsy Society (AES) comprehensive review of the treatment of convulsive refractory status epilepticus (RSE). Methods: We sought to determine the effectiveness of treatment options for SRSE. We performed a structured literature search (MEDLINE, Embase, CENTRAL, CINAHL) for studies on reported treatments of SRSE. We excluded antiseizure medications (ASMs) covered in the 2016 AES guideline on the treatment of established SE and the convulsive RSE comprehensive review of the 2020 AES. Literature was reviewed on the effectiveness of vagus nerve stimulation, ketogenic diet (KD), lidocaine, inhalation anesthetics, brain surgery, therapeutic hypothermia, perampanel, pregabalin (PGB), and topiramate in the treatment of SRSE. Two authors reviewed each therapeutic intervention. We graded the level of the evidence according to the 2017 classification scheme of the American Academy of Neurology. Results: For SRSE (level U; 39 class IV studies total), insufficient evidence exists to support that perampanel, PGB, lidocaine, or acute vagus nerve stimulation (VNS) is effective. For children and adults with SRSE, insufficient evidence exists to support that the KD is effective (level U; 5 class IV studies). For adults with SRSE, insufficient evidence exists that brain surgery is effective (level U, 7 class IV studies). For adults with SRSE insufficient, evidence exists that therapeutic hypothermia is effective (level C, 1 class II and 4 class IV studies). For neonates with hypoxic-ischemic encephalopathy, insufficient evidence exists that therapeutic hypothermia reduces seizure burden (level U; 1 class IV study). For adults with SRSE, insufficient evidence exists that inhalation anesthetics are effective (level U, 1 class IV study) and that there is a potential risk of neurotoxicity. Conclusion: For patients with SRSE insufficient, evidence exists that any of the ASMs reviewed, inhalational anesthetics, ketogenic diet, acute VNS, brain surgery, and therapeutic hypothermia are effective treatments. Data supporting the use of these treatments for SRSE are scarce and limited mainly to small case series and case reports and are confounded by differences in patients’ population, and comedications, among other factors.

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Section: Resultsmentioning

confidence: 99%

Section: Topiramatementioning

confidence: 99%

Treatment of Super-Refractory Status Epilepticus: A Review

et al. 2021

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“…Examples are the premature use of bumetanide (Pressler et al, 2015;Vanhatalo et al, 2009;Kharod et al, 2019) or topiramate (Kundak et al, 2012;Filippi et al, 2017;Courchia et al, 2018) in the treatment of neonatal seizures.…”

Section: Evidence Base Of Current Neonatal Seizure Treatmentmentioning

confidence: 99%

Why we urgently need improved seizure and epilepsy therapies for children and neonates

Pressler

Lagae

2020

Neuropharmacology

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In contrast to epilepsy in adolescents and adults, neonatal seizures and early onset epilepsy poses unique challenges with significant repercussion for treatment choices. Most importantly, high seizure burden and epileptic encephalopathy are associated with developmental, behavioural and cognitive problems. The causes are multifactorial and include etiology, seizure burden, epileptic encephalopathy, but also antiseizure medication. In contrast to adults and older children only very few drugs have been licenced for infants and neonates, and after a long delay. Very recently, extrapolation of adult data has become possible as a path to speed up drug development for younger children but this is not necessarily possible for infants and neonates. With the advances in understanding the molecular basis of many epilepsies, targeted therapies become available, for example for KCNQ2 mutation related epilepsies, Dravet syndrome or tuberous sclerosis complex. Drug trials in neonates are particularly challenging because of their inconspicuous clinical presentation, the need for continuous EEG monitoring, high co-morbidity, and poor response to antiepileptic drugs. There is an urgent need for development of new drugs, evaluation of safety and efficacy of current antiseizure drugs, as well as for national policies and guidelines for the management of seizures and epilepsy in neonates and infants. Highlights  Treatment of early onset seizures and epilepsies pose a clinical challenge to clinicians.  Only very few drugs have been licenced due to lack of randomised controlled trials.  Systematic reviews no good evidence for the choice of treatment.  Precision medicine is so far only available for a small number of syndromes.

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“…However, Courchia et al recently published a case series of four premature neonates who developed clinical and radiographic signs of necrotizing encephalitis after receiving topiramate for seizure treatment. 60 Further research regarding the safety of topiramate use is needed.…”

Section: Treatment Of Refractory Seizuresmentioning

confidence: 99%

Recent Advances in the Diagnosis and Treatment of Neonatal Seizures

Samanta

2020

Neuropediatrics

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Seizures are the most common neurological emergency in the neonates, and this age group has the highest incidence of seizures compared with any other period of life. The author provides a narrative review of recent advances in the genetics of neonatal epilepsies, new neonatal seizure classification system, diagnostics, and treatment of neonatal seizures based on a comprehensive literature review (MEDLINE using PubMED and OvidSP vendors with appropriate keywords to incorporate recent evidence), personal practice, and experience. Knowledge regarding various systemic and postzygotic genetic mutations responsible for neonatal epilepsy has been exploded in recent times, as well as better delineation of clinical phenotypes associated with rare neonatal epilepsies. An International League Against Epilepsy task force on neonatal seizure has proposed a new neonatal seizure classification system and also evaluated the specificity of semiological features related to particular etiology. Although continuous video electroencephalogram (EEG) is the gold standard for monitoring neonatal seizures, amplitude-integrated EEGs have gained significant popularity in resource-limited settings. There is tremendous progress in the automated seizure detection algorithm, including the availability of a fully convolutional neural network using artificial machine learning (deep learning). There is a substantial need for ongoing research and clinical trials to understand optimal medication selection (first line, second line, and third line) for neonatal seizures, treatment duration of antiepileptic drugs after cessation of seizures, and strategies to improve neuromorbidities such as cerebral palsy, epilepsy, and developmental impairments. Although in recent times, levetiracetam use has been significantly increased for neonatal seizures, a multicenter, randomized, blinded, controlled phase IIb trial confirmed the superiority of phenobarbital over levetiracetam in the acute suppression of neonatal seizures. While there is no single best choice available for the management of neonatal seizures, institutional guidelines should be formed based on a consensus of local experts to mitigate wide variability in the treatment and to facilitate early diagnosis and treatment.

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Topiramate for Seizures in Preterm Infants and the Development of Necrotizing Enterocolitis

Cited by 13 publications

References 12 publications

Treatment of Super-Refractory Status Epilepticus: A Review

Treatment of Super-Refractory Status Epilepticus: A Review

Why we urgently need improved seizure and epilepsy therapies for children and neonates

Recent Advances in the Diagnosis and Treatment of Neonatal Seizures

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