Abstracts

RATIONALE:_Topiramate (TPM), a new antipepileptic drug, has been licensed for the add-on treatment of drug-resistant partial epilepsy. To our knowledge, no case of modification of seizure semeiology has been reported during TPM add-on treatment. METHODS: Clinical and neurophysiologic evaluation in two patients with partial epilepsy. RESULTS:_PATIENT 1. Female, 38 years. Diagnosis: symptomatic partial epilepsy (mesial temporal sclerosis). Seizure onset: 6 years. Persistence of "classical" temporo-mesial partial seizures despite adequate carbamazepine treatment. After the introduction of TPM at a maximal dose of 100 mg pro die the patient experienced the occurrence of a constant falling component in the final phase of the episode. Nocturnal seizures were documented during a video-EEG recording. "New" seizures disappeared with TPM stopping. PATIENT 2. Female, 20 years. Diagnosis: cryptogenetic partial epilepsy (right frontal lobe origin). Seizure onset: 6 years. Persistence of dystonic frontal lobe seizures despite adequate carbamazepine and phenobarbital treatment. After the introduction of TPM at a maximal dose of 450 mg pro die the patient experienced the occurrence of constant nocturnal seizures different from her usual ones: they were characterized by a "terrific" initial component, minimal consciousness impairment, dystonic posture of upper limbs and neck, very short duration. A video-EEG recording documented a "new" left frontal epileptic focus. "New" seizures disappeared with TPM stopping. After lamotrigine introduction the patient became seizure-free. CONCLUSIONS:_No case of appearance of new seizures and/or modification of semeiology or pre-existent seizures has been reported with TPM treatment. Anyway, our anecdotical description needs to be confirmed with large observational studies.