Topiramate in Patients with Learning Disability and Refractory Epilepsy

Abstract

Summary:Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre.Methods: Sixty-four patients (36 men, 28 women, aged 16-65 years) were begun on adjunctive TPM after a 3-month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6-month period at optimal TPM dosing. These were seizure freedom or Ն50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study.Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on Յ200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add-on therapy in learning-disabled people with difficult-to-control epilepsy. Seizure freedom is a realistic goal in this population.

Update on treatment of epilepsy in people with intellectual disabilities

“…Previous studies [1,2] in PWID came to similar conclusions: high efficacy but an increased rate of mainly central nervous side effects like sedation, behaviour problems and deterioration of neurological status.…”

Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [RETIRED]

“…[58][59][60][61][62][63][64][65][66][67] No outcomes relevant to generalized seizures only can be assessed.…”

Die neuen Antiepileptika in der Epilepsiebehandlung von Patienten mit geistiger Behinderung*

“…Vierundsechzig erwachsene (ab 16 Jahre) Patienten mit Intelligenzminderung aller Schweregrade und therapieresistenter Epilepsie, definiert als mindestens 5 Anfälle pro Monat trotz mindestens 4 Mono-oder Kombinationstherapien, wurden in einer offenen prospektiven Studie mit Topiramat zusätzlich zur vorhandenen Medikation behandelt [25]. Sechszehn Patienten (25%) waren für den Beobachtungszeitraum von mindestens 6 Monaten anfallsfrei, weitere 29 (45%) hatten eine mindestens 50%ige Anfallsreduktion.…”