Abstracts

Topiramate (TPM) is a novel antiepileptic drug available in the United States for the treatment of epilepsy since 1996. It was approved for use as adjunctive therapy for adults and children older than 2 years with partial or primary generalized onset seizures.The purpose of this study was to review our clinical experience with TPM in a pediatric population.
We retrospectively analyzed the charts of 29 children with a variety of epileptic syndromes who began treatment with TPM from Oct 1999 to Feb 2003. TPM was given at an initial dose of 1-3 mg/kg/day ,and increased up to a maintenance dose of 5-9 mg/kg/day in 2 divided doses.Ages ranged from 3 months to 18 years. Demographics, seizure type, previous AEDs, dose, concomitant AEDs and adverse events were recorded.
Twenty nine patients were included, 17 boys and 12 girls, ranging in age from 2 to 18 years. Fifteen, had partial epilepsy, 14 primary generalized including 3 with absence epilepsy. Associated disorders were present in the majority , and included mental retardation, attention deficit hyperactivity disorder, cerebral palsy, hydrocephalus and tic disorder.Patients were taking up to the 3 AEDs at the time TPM was added.Seven patients were able to convert to monotherapy. Efficacy of [ge]50 % seizure reduction was found in seventeen patients ( 70%) .Three remain seizure free for the duration of the study.AEs included behavioral changes, lethargy, cognitive impairment, slurred speech and undesirable weight loss.Three patients experienced beneficial weight loss.Six patients discontinued treatment due to lack of efficacy. Five due to AEs. One due to difficulty with dosification.
Topiramate appeared to be effective and well tolerated in our pediatric patients with partial and generalized onset epilepsy. It provided significant improvement in seizure control in 70% of our patients. Monotherapy is possible and desirable with this broad spectrum medication..