CLINICAL EXPERIENCE WITH TOPIRAMATE MONOTHERAPY IN ADULTS WITH REFRACTORY EPILEPSY
Abstract number :
2.282
Submission category :
Year :
2003
Submission ID :
2092
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
James P. Valeriano, Carole Lane Department of Neurology, Allegheny Neurological Associates, Pittsburg, PA
Monotherapy remains the preferred mode of drug therapy in epilepsy, even though a variety of new antiepileptic drugs (AEDs) have become available based on evidence of improved seizure control with add-on therapy. Monotherapy is generally better tolerated and is certainly simpler to manage. As an add-on agent in refractory partial-onset seizures, topiramate (TPM) appears to be one of the more effective AEDs of the newer generation agents. We report on the successful conversion of adults with refractory epilepsy to topiramate (TPM) monotherapy.
A case record review identified 22 adults who are currently receiving TPM monotherapy, all but one of whom had failed previous AED therapy because of inadequate seizure control or side effects. Using a standardized data collection form, treatment data were extracted for analysis.
For these 22 patients, mean age was 40 yrs (range, 15-60 yrs) and 73% (16/22) were female. Mean duration of epilepsy was 20 yrs (range, 0.8-45 yrs); 59% (13/22) had partial-onset seizures with/without secondary generalization, 36% (8/22) had generalized tonic-clonic seizures with/without other generalized seizures, and one (5%) patient had both partial-onset and generalized seizures. Half (11/21) of patients had previously failed treatment with 1 or 2 AEDs; 33% (7/21) had failed 4 or more AEDs previously. Among 60 trials of AED therapy in these 21 patients, 31 were discontinued primarily due to adverse effects and 29 were discontinued largely because of inadequate seizure control. With TPM monotherapy, 64% (14/22) of patients were seizure-free for periods as long as 45 months (mean, 19 mos). In those patients who were not seizure-free, seizures were reduced [ge]90% in 1 patient, [ge]80% in 3 patients, and [ge]50% in 1 patient; 2 patients showed no change in seizure frequency. Median TPM dose was 275 mg/day (range, 150-550 mg/day); median treatment duration was 23 mos (range, 0.2-73 mos). In these patients, TPM treatment was well tolerated, although one patient discontinued TPM due to side effects (slowed thinking).
These retrospective findings show that TPM monotherapy can be successful in patients with refractory epilepsy who have failed previous AED therapy.
[Supported by: Ortho-McNeil Pharmaceutical.]