Abstracts

Rationale: A small number of reports have described the use of topiramate (TPM) in refractory status epilepticus (RSE). The aim of the current study was to explore the feasibility, the safety profile and the efficacy of enterally administered TPM as an adjunctive treatment for adult patients with RSE. Methods: This prospective open-label non-randomized clinical trial was performed at Namazee hospital, Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 through February 2014. Patients 18 years of age and older with generalized convulsive status epilepticus (SE) were enrolled. Topiramate was used as an add-on treatment, in case of failure of at least two standard anti-epileptic drugs in patients in whom the standard third line therapy was not available or possible, or ICU was not accessible to start the line four of therapy for SE. Topiramate tablets were crushed and administered through the nasogastric tube. Topiramate dose was 400 mg stat and then 200 mg Bid. Status epilepticus response to TPM was categorized as successful, possible or unsuccessful. Results: Twenty patients (14 males and 6 females) were enrolled in the study. Topiramate was successful in terminating SE in five (25%) patients; possibly successful in stopping SE in 11 (55%) patients; and not successful in four (20%) patients. We did not observe any clinically significant adverse effects related to TPM administration. Eleven (55%) patients returned to their baseline clinical condition at the time of discharge from the hospital, but two (10%) patients did not. Seven (35%) patients died in the hospital. Conclusions: Treatment with enterally administered topiramate showed to be efficacious, feasible, and well tolerated in patients with RSE. Low cost and feasibility makes TPM a useful agent in treating patients with RSE.