Add-on therapy with topiramate in drug-resistant epilepsy

ABSTRACT

Intractable epilepsy is defined as epilepsies that are not controled with routine pharmacologic therapy. The present study was conducted to evaluate the efficacy and side effects of topiramate as an add-on therapy in drug-resistant [intractable] epilepsies.For this quasi experimental study 42 children who have referred to Mofid hospital with refractory epilepsy were enrolled. The study population included 14 girls and 28 boys, aged 1-15 years. Seizure attacks were not controlled despite receiving 4-13 drugs [mean 9]. Topiramate was added to the patient's drug in a 4-week titration regimen [1st week 3, 2nd week 5, 3rd week 7, and 4th week 9mg/kg]. Then, after 3 months he/she was reevaluated. Of 42 patients, Lennox-Gastaut syndrome, idiopathic epilepsy, symptomatic epilepsy, and progressive myoclonic epilepsy were revealed in 14 [34%], 8[19%], 16[38%], and 4[9%], respectively. After the 3-month add-on therapy with topiramate, 17% became seizure-free and the frequency of seizure attacks decreased by 50% in 26% of the patients, however, attacks were exacerbated in 5%. Fortunately, hematologic, renal or hepatic side effects were not reported, however, mild transient neurologic complications were observed in 12% of the patients. We have noticed a satisfactory response to topiramate, thus, it can be safely prescribed for intractable seizures