An open trial of topiramate as add-on therapy in children with refractory epilepsy

Woo, Young Jong; Lee, Hyeon Seung; Ju, Seong Woo; Choi, Young Ryun; Kim, Jae Hyu

Abstract

28 cases of intractable childhood epilepsy aged of 1 year 3 months through 17 years 5 months have been treated with topiramate (TPM) as a add-on base from April, 1999. During the titration phase of 8 weeks initial dose of 1mg/kg/day TPM was given in addition to their current antiepileptic therapy. Dosage was slowly increased by 1mg/kg/day every 7 days until seizure was controlled or maximal tolerated dose was achieved. Efficacy was assessed by the reduction of seizure frequency. 50% or more reduction in seizure frequency (Good responder) was observed in 15 cases (53.7%) including complete seizure remission in 5 (17.9%). 46.7% of refractory complex partial seizures (7/15) experienced Good response, but 3 cases of Lennox-Gastaut syndromes showed minimal seizure reduction or no response up to the dosage of 10mg/kg/day. Efficacy was evident with doses between 3 and 13mg/kg/day. 12 cases (42.9%) on topiramate experienced adverse effects of sleepiness, anorexia, insomnia or aggravation of seizures which caused the medication withdrawal in two patients. Topiramate is effective and may be considered as part of the treatment pathway for intractable epileptic seizures in children, although careful monitoring of cognitive function is required.