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Topiramate in Intractable Childhood Onset Epilepsy - A Cautionary Note

Published online by Cambridge University Press:  02 December 2014

J.M. Dooley ,
P.R. Camfield ,
E. Smith ,
P. Langevin  and
G. Ronen
J.M. Dooley
Affiliation:
Neurology Division, IWK~Grace Health Centre, Halifax, NS
P.R. Camfield
Affiliation:
Neurology Division, IWK~Grace Health Centre, Halifax, NS
E. Smith
Affiliation:
Neurology Division, IWK~Grace Health Centre, Halifax, NS
P. Langevin
Affiliation:
Neurology Division, IWK~Grace Health Centre, Halifax, NS
G. Ronen
Affiliation:
Neurology Division, IWK~Grace Health Centre, Halifax, NS
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Abstract

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Objectives:

To study the effectiveness and safety of topiramate in clinical practice, for a group of patients with childhood onset epilepsy.

Methods:

All patients treated with topiramate at the three study centers between November 1995 and December 31, 1997 were analyzed retrospectively, using a standardized study protocol. Data were gathered on demographic features, seizure response and medication related adverse events.

Results:

Eighty-seven patients were treated with topiramate. Over 90% seizure reduction was achieved in 8 (9%) patients, 50%-90% in 21 (24%), <50% in 54 (62%) patients. Four patients (5%) had a deterioration in seizure control. Adverse events required topiramate discontinuation in 36 (41%). Of these 27 (31%) complained of unacceptable cognitive dulling. The rate of dose escalation and final dose in mg/kg were similar in those who remained on topiramate and those who were intolerant because of cognitive side effects.

Conclusion:

Although topiramate resulted in >50% seizure reduction in 29 (33%) of this group of patients with difficult epilepsy, its usefulness was limited by a high incidence of adverse effects. Adverse events prevented ongoing therapy for 36 (41%) and cognitive dulling resulted in topiramate discontinuation by 27 (31%) of the group.

Résumé

RÉSUMÉObjectifs:

Le but de cette étude était d’examiner l’efficacité et la sécurité du topiramate en pratique clinique dans le traitement de patients dont l’épilepsie a débuté dans l’enfance.

Méthodes:

Les dossiers de tous les patients traités par le topiramate dans les trois centres qui participaient à l’étude entre novembre 1995 et le 31 décembre 1997 ont été analyses rétrospectivement au moyen d’un protocole standardisé. Des données sur la démographie, la réponse au traitement et les problèmes de santé associés à la médication ont été recueillies.

Résultats:

Quatre-vingt-sept patients ont été traités par le topiramate. Une diminution de plus de 90% des crises a été obtenue chez 8 patients (9%), 50%-90% chez 21 (24%), <50% chez 54 (6%). Chez 4 patients (5%) le contrôle des crises s’est détérioré. Le topiramate a été cessé chez 36 patients (41%) à cause de problèmes de santé associés au médicament, dont 27 patients (31%) qui ont présenté un amoindrissement inacceptable des fonctions cognitives. L’augmentation des doses et la dose finale en mg/kg étaient semblables chez ceux qui ont continué à prendre le médicament et chez ceux qui étaient intolérants à cause d’effets secondaires cognitifs.

Conclusions:

Bien que le topiramate a produit une diminution des crises >50% chez 29 patients (33%) de ce groupe de patients ayant une épilepsie difficile à contrôler, son utilité est limitée par une incidence élevée d’effets secondaires. Les effets secondaires ont motivé l’arrêt de cette médication chez 36 patients (41%) et l’amoindrissement des fonctions cognitives a été le motif de cet arrêt chez 27 patients (31%) du groupe.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 4 , November 1999 , pp. 271 - 273
Copyright
Copyright © The Canadian Journal of Neurological 1999

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