Abstracts

RATIONALE: Topiramate (TPM) is a novel antiepileptic drug (AED) approved within the past year as adjunctive therapy with partial seizures in children, ages 2-16. The long-term safety, efficacy, and individual clinical experience of TPM in pediatric patients have not been fully established. The purpose of this study was to review clinical use of TPM in a variety of childhood syndromes and refractory seizure types. METHODS: Pediatric patients who had continued seizures despite adequate trials of standard AED(s) were started on TPM at 1 mg/kg/day and titrated as tolerated. They were prospectively followed for efficacy (>50% seizure reduction) and adverse effects. RESULTS: Nineteen patients (age range: 2-18 years old) were entered into the analysis. Seizures were classified as generalized (N=9) and complex partial with secondary generalization (N=10). Three had Lennox Gastaut. Associated disorders were present in the majority and included: tuberous sclerosis, OTC deficiency, mental retardation, developmental delay, attention deficit disorder, cerebral palsy, hydrocephalus, cortical heterotropia, depression, psychosis, subdural empyema after bacterial meningitis, and spinal cord ependymoma. Four had vagus nerve stimulators. All were on 1-2 other AED(s) when TPM was added. Mean duration of treatment at the last clinic visit was 6 months. Efficacy of >50% seizure reduction was reported in 33% of these patients with transient improvement noted in an additional 2 patients. Of the 3 patients with Lennox Gastaut, 2 had a significant decrease of >50% seizure frequency. Sedation was a prominent side effect (N=3) and persisted despite slow titration. Two patients experienced severe behavioral changes causing TPM to be withdrawn. One had severe weight loss causing the drug to be discontinued. CONCLUSIONS: TPM was well tolerated in the majority (73%) of this varied pediatric population with multiple concomitant illnesses. Approximately one third had a significant decrease in seizure severity and frequency (>50% reduction).