Topiramate in children and adolescents with epilepsy

Objective: To evaluate the efficacy and tolerability of flexible doses of topiramate (Topamax®; TPM) in children and adolescents with epilepsy independent of seizure type and epilepsy syndrome.

Methods: Prospective multicenter observational study. In- and outpatients 2–16 years of age with epilepsy were evaluated at baseline and after 12 and 24 weeks.

Results: 176 patients (53% male, mean age 8.9 years) were followed for a median of 181 days. 46% had symptomatic, 28% idiopathic and 26% kryptogenic epilepsy. 65% had partial and 29% had generalized seizures, 6% were unclassified. TPM was introduced mainly due to persisting seizures (73%) or side effects (26%) with the previous AED. The mean daily dose of topiramate at endpoint was 3.3±2.0mg/kg body weight in monotherapy (45% of patients) and 4.5±3.8mg/kg in combination (55% of patients). In 30/96 patients with combination therapy at baseline (31.3%) at least one concomitant antiepileptic drug could be tapered off during the study, 15 of those patients could be converted to TPM monotherapy. Median seizure frequency improved substantially from 16 (3-month retrospective baseline) to 2 in the last 3 months of the study. Median seizure reduction was 90%. Seizure reduction was significant not only for partial but also for primary generalized including absence (77% responders) and myoclonic seizures (79.6% responders). 40.5% of the patients remained seizure free for more than 3 months. The only adverse event ≥ 5% was somnolence (8.5%). Cognitive adverse events such as language problems (4.5%), difficulties with thinking (4.5%) or concentration (2.3%) were infrequent.

Conclusion: In children and adolescents between 2 and 16 years of age topiramate was associated with a substantial reduction in seizure frequency and well tolerated. The high responder rates for both partial and primary generalized including absence and myoclonic seizures support recent results about the broad spectrum efficacy of topiramate in this age group.