Abstracts

To evaluate the efficacy and tolerability of topiramate (Topamax[reg], TPM) in mono- or combination therapy in elderly patients with epilepsy. Prospective multicenter observational study. Patients = 60 years of age were evaluated at baseline and after 12 and 24 weeks. Doses of TPM and concomitant AEDs could be adjusted individually. Seizure frequency and adverse events (AEs) were assessed at every visit. 108 patients (47.2% male, mean age 71 [plusmn] 8 years, mean time since epilepsy diagnosis 12 years, 79.6% partial epilepsy) were prospectively followed for 24 weeks. Etiology was symptomatic in 67.6%, kryptogenic in 9.3% and idiopathic in 22.2%. The most frequent seizure types were generalized tonic-clonic seizures (72.2%), complex partial (25.0%), simple partial (19.4%) and absence seizures (12.0%). 58 patients were treated with TPM in monotherapy (mean dose at endpoint 93 [plusmn] 10 mg/day), 50 patients in combination therapy with one or two other antiepileptic drugs (mean TPM dose at endpoint 93 [plusmn] 8 mg/day). Mean baseline seizure frequency was 7 [plusmn] 10.4 in the 12-week retrospective baseline and decreased to 1.6 [plusmn] 3.2 at endpoint (p[lt]0.0001). The responder rate (seizure reduction = 50%) was 87.6%, and 56.5% of the patients remained seizure-free for at least the last three months of the trial. 83.3% of the patients completed the study. Main reasons for drop-out were lack of tolerability (8.3%) and loss to follow-up (4.6%). Overall, 21 patients (19.4%) had at least one AE. The most frequently reported AEs were somnolence (3.7%), dizziness (3.7%) and decreased appetite (2.8%). Psychomotor slowing was reported in two and memory difficulties in one patient. Mean weight change from baseline to endpoint was -0.9 kg. In elderly patients with epilepsy, TPM was associated with a significant decrease in seizure frequency both in mono- and combination therapy. Monotherapy doses used for elderly patients were slightly below the recommended target dose of 100 mg/day, while in combination therapy a considerably lower dose was used compared to the recommended target dose of 200 mg/day for adults. (Supported by Janssen-Cilag Germany)