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Topiramate Use in Pediatric Patients

Published online by Cambridge University Press:  18 September 2015

Tracy A. Glauser
Tracy A. Glauser*
Affiliation:
Children's Comprehensive Epilepsy Program, Department of Neurology, Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
*
Director, Children's Comprehensive Epilepsy Program, Department of Neurology, OSB-5, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, U.S.A., 45229-3039
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Abstract:

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Topiramate (TPM), a new antiepileptic medication, is efficacious as adjunctive therapy in adults with partial onset seizures. Its efficacy as adjunctive therapy in children was evaluated in two randomized double-blind placebo-controlled trials involving childhood epileptic encephalopathy (the Lennox-Gastaut syndrome) and partial onset seizures. In these studies, topiramate adjunctive therapy resulted in a significant reduction in drop attacks (tonic or atonic seizures) in patients with the Lennox Gastaut syndrome and a significant reduction in partial onset seizures in children with refractory partial epilepsy. In both trials, TPM's efficacy improved as the dose escalated from the double-blind phase to the open-label portion. The minimally effective topiramate dose for adjunctive therapy in children with refractory epilepsy appears to be 6 mg/kg/day. Topiramate was well tolerated with mild or moderate side effects, predominantly related to the central nervous system. Practical tips are provided that may increase the chance that topiramate will be effective and well tolerated. The most important advice is a “start low, go slow” approach. An initial TPM dose of 0.5 - 1 mg/kg/day followed by weekly increments of 0.5 - 1 mg/kg is usually well tolerated. Based on these studies, topiramate appears to be an important addition to our pediatric AED armamentarium.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue S3 , August 1998 , pp. S8 - S12
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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