Abstracts

RATIONALE: The specificity of antiepileptic drugs (AEDs), particularly within partial epilepsy syndromes, is relatively limited. Paradoxical aggravation of certain types of epilepsies with AEDs is well recognized. Topiramate proved to be a very efficacious drug for the control of partial seizures in adults and children. Recent open studies suggest specific efficacy for the control of seizures originating from the central regions. Anecdotal reports describe possible aggravation of frontal seizures in adults. Knowledge of cases of aggravation from a given drug, in well defined epilepsy syndromes, helps in elaborating therapeutic strategies.
METHODS: We report the electroclinical characteristics of two children presenting with drug resistant, frontal, cryptogenic epilepsy clearly aggravated by the use of Topiramate (TPR).
RESULTS: Case 1, a child of 5 years old, with a personal history of one febrile seizure at the age of 8 months, developed an uncontrolled partial epilepsy at 4 years. Clinical semiology was clearly in favour of frontal seizures; Interictal EEG and SPECT showed a left frontal focus. Initially treated unsuccessfully with valproate, he remained seizure free for 8 months under carbamazepine. At the age of 5 years, TPR was progressively associated because of recurrence of seizures. At a dose of 2.5 mg/kg/day frequency of seizures augmented to at least 15 per day, cognitive deterioration was evident and the EEG showed complete disorganisation with diffuse slowing. Discontinuation of TPR was immediately followed by a return in the previous electroclinical pattern.
Case 2, a girl of 4 years old, presented with cryptogenic right frontal epilepsy at 33 months of age. Treated with carbamazepine she remained seizure free during 7 months. Following recurrence of seizures, carbamazepine was progressively replaced by TPR up to 10 mg/kg/day. Frequency of seizures remained at approximately 5/day but was accompanied by a clear modification in the duration of each episode (10 to 20 minutes instead of 1 to 2 min. prior to TPR). Discontinuation of TPR allowed return to baseline pattern.
CONCLUSIONS: In our cases we cannot exclude a fortuitous aggravation related to the habitual fluctuating evolution of frontal epilepsies. However, the particular pattern of aggravation in seizure frequency and EEG aspect, the associated cognitive dysfunction and the modifications in seizure semiology suggest relationship to TPR treatment. Predictive factors for patients to develop aggravation with Topiramate are yet to be fully defined, to allow better clinical use of this very efficacious AED.