Abstracts

RATIONALE:_Status epilepticus(SE)is associated with significant morbidity and mortality. Various protocols have been used to treat this serious condition including benzodiazepines, phenytoin, barbiturates and general anesthetic agents. We report 5 patients aggressively treated for status epilepticus who experienced resolution of their seizures only after the administration of topiramate. METHODS: From 12/11/98 to 7/28/99 five patients were identified from the Greater Richmond Status Epilepticus database who were treated for refractory SE with topiramate. Continuous EEG monitoring demonstrated partial or generalized epileptiform activity which was continuous or intermittent over a period of at least 30 minutes. These patients had been treated according to our standard protocol including benzodiazepines, fosphenytoin, barbiturates, valproic acid, IV midazolam or pentobarbital. None of these patients were adequately controlled by traditional anticonvulsants used for status epilepticus. They were then started on topiramate by nasogastric (NG) tube at a maximum dose of 1600 mg a day. RESULTS: Five patients with refractory status epilepticus treated with a standard protocol were started on topiramate by nasogastric route. When the patients were unresponsive to traditional therapies, nasogastric topiramate was added to the regimen. The dose escalation and maximum dose varied according to the patient; however, no patient received greater than 1600 mg in a 24 hour period. In all of the five cases, the ictal activity resolved and the patients were eventually discharged from the hospital either to home or to a rehabilitation facility. CONCLUSIONS: This report demonstrates the efficacy of topiramate therapy in patients with refractory status epilepticus. Although an IV formulation is not available, this medication can be given by other routes such as NG or gastrostomy tube. Because of its broad mechanisms of action, topiramate would be expected to be effective in multiple seizure types. Although not a first line treatment in status epilepticus, topiramate should be considered after other options have failed.