Abstracts

RATIONALE:_To evaluate the efficacy and safety of Topiramate (TPM) as add-on therapy in a group of children previously resistant to antiepileptic drugs. METHODS: The patients, evaluated in four Italian Epilepsy centers, were 106, 53 female and 53 males, mean age 13 years (range 5-23). 73 patients were affected by partial epilepsy (8 cryptogenic, 65 symptomatic), 28 by Lennox-Gastaut syndrome, 3 by Severe Myoclonic Epilepsy of Infancy (SMEI) and 2 by Myoclonic-Astatic Epilepsy. All patients were in politherapy with a median baseline seizure rate of 3 seizure/die. The mean TPM daily dose was 4 mg/kg (range 2-8) and mean follow up was 8 month (range 2-19). RESULTS: 35 of the 73 patients with partial epilepsy (47.9%) showed >50% seizures reduction (responders): 8 of these patients (10,9%) were seizure free. The best result was obtained in patients with symptomatic epilepsy with complex partial seizures with secondarily generalisation. 11 of the 28 patients with Lennox-Gastaut Syndrome (39.2%) were responders: none of the patient was seizures free. All the 3 patients with SMEI and 1 of the 2 patients with Myoclonic-Astatic Epilepsy were responders. 39 of our patient (40%) presented adverse events: 23 (21.6%) had loss of weight, 19 (17,9%) experienced somnolence and 4 (3,7%) reported severe cognitive effects. CONCLUSIONS:TPM is safe and effective in refractory partial and generalised paediatric epilepsies. We found the efficacy was greatest on complex partial with secondarily generalised seizures in patients with symptomatic partial epilepsy (48% responders) and on tonic seizure in patients with Lennox-Gastaut Syndrome (39% responders). Although we obtained a optimum response in SMEI and in Myoclonic-Astatic Epilepsy, further studies are needed to verify the efficacy of TPM in these two epileptic syndromes.