Treatment of Refractory Neonatal Seizures with Topiramate

Abstract

Objective The objective of this study is to describe the usefulness of topiramate in refractory neonatal seizures.

Results We reported the clinical off-label use of topiramate in three cases of refractory neonatal seizures of unclear origin with no response to conventional antiepileptic drugs. In all cases, the seizures were completely controlled with adding topiramate. All patients became seizure free during hospitalization and were followed by approximately 1 year after hospital discharge, with monotherapy with topiramate.

Comments The clinical off-label use of topiramate in neonatal seizures is still incipient. When searching publications in this matter, only one report was identified. Because of its efficacy for both seizures and neuroprotection, topiramate could be a useful choice in refractory neonatal seizures.

Keywords

neonatal - seizures - topiramate

• References

• 1 Wirrell EC. Neonatal seizures: to treat or not to treat?. Semin Pediatr Neurol 2005; 12 (2) 97-105
• 2 Volpe JJ. Neonatal seizures. In: Volpe JJ, , ed. Neurology of the Newborn. 5th ed. Philadelphia: Saunders Company; 2008: 172-210
• 3 Zhao Q, Hu Y, Holmes GL. Effect of topiramate on cognitive function and activity level following neonatal seizures. Epilepsy Behav 2005; 6 (4) 529-536
• 4 Glass HC, Poulin C, Shevell MI. Topiramate for the treatment of neonatal seizures. Pediatr Neurol 2011; 44 (6) 439-442
• 5 Silverstein FS, Ferriero DM. Off-label use of antiepileptic drugs for the treatment of neonatal seizures. Pediatr Neurol 2008; 39 (2) 77-79
• 6 Cha BH, Silveira DC, Liu X, Hu Y, Holmes GL. Effect of topiramate following recurrent and prolonged seizures during early development. Epilepsy Res 2002; 51 (3) 217-232
• 7 Glier C, Dzietko M, Bittigau P, Jarosz B, Korobowicz E, Ikonomidou C. Therapeutic doses of topiramate are not toxic to the developing rat brain. Exp Neurol 2004; 187 (2) 403-409
• 8 Kim J, Kondratyev A, Gale K. Antiepileptic drug-induced neuronal cell death in the immature brain: effects of carbamazepine, topiramate, and levetiracetam as monotherapy versus polytherapy. J Pharmacol Exp Ther 2007; 323 (1) 165-173
• 9 Hosain SA, Merchant S, Solomon GE, Chutorian A. Topiramate for the treatment of infantile spasms. J Child Neurol 2006; 21 (1) 17-19
• 10 Bassan H, Bental Y, Shany E , et al. Neonatal seizures: dilemmas in workup and management. Pediatr Neurol 2008; 38 (6) 415-421