Topiramate for the treatment of intractable childhood epilepsy

OBJECTIVE: Topiramate (TPM) is a new antiepileptic drug, which has a wide spectrum of activities suggesting a potentially valuable therapeutic profile. Our objective is to report our experience in treating children with intractable epilepsy.

METHODS: Prospective, open label, add on trial of TPM in treating consecutive children with intractable epilepsy (defined as recurrent seizures after at least 3 antiepileptic medication trials) seen between May 1, 1999 and April 28, 2002 at King Faisal Specialist Hospital and Research Centre and King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Follow up by 2 pediatric neurologists was performed. Therapeutic response was recorded as complete (no seizures), good (>50% seizure reduction), fair (<50% seizure reduction), or none.

RESULTS: Sixty-two children (36 males and 26 females) aged between 2 months and 16 years (mean 6 years) were treated with TPM and followed for up to 3 years (mean 15 months). Most children (55%) had daily seizures and were tried on multiple antiepileptic drugs (mean 4.6). Nineteen (31%) children had Lennox-Gastaut syndrome. After the introduction of TPM, 21 (34%) became completely seizure free and 24 (39%) had >50% seizure reduction. Children with daily seizures were reduced from 55% before TPM to 13% on TPM (p=0.0007). Side effects were reported in 21 (34%) children in the form of decreased appetite, weight loss, and sedation. The majority was transient; however, TPM had to be withdrawn in 7 (11%) children because of progressive weight loss or seizure worsening. Follow up renal ultrasound was performed on 34 (55%) children and was always normal.

CONCLUSION: Topiramate is a very effective antiepileptic drug with a broad spectrum of antiepileptic activities. Most side effects were transient, however, careful monitoring of body weight is recommended.