ABSTRACT
OBJECTIVE: Topiramate (TPM) is a new antiepileptic drug, which has a wide spectrum of activities suggesting a potentially valuable therapeutic profile. Our objective is to report our experience in treating children with intractable epilepsy. METHODS: Prospective, open label, add on trial of TPM in treating consecutive children with intractable epilepsy (defined as recurrent seizures after at least 3 antiepileptic medication trials) seen between May 1, 1999 and April 28, 2002 at King Faisal Specialist Hospital and Research Centre and King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Follow up by 2 pediatric neurologists was performed. Therapeutic response was recorded as complete (no seizures), good (>50% seizure reduction), fair (<50% seizure reduction), or none. RESULTS: Sixty-two children (36 males and 26 females) aged between 2 months and 16 years (mean 6 years) were treated with TPM and followed for up to 3 years (mean 15 months). Most children (55%) had daily seizures and were tried on multiple antiepileptic drugs (mean 4.6). Nineteen (31%) children had Lennox-Gastaut syndrome. After the introduction of TPM, 21 (34%) became completely seizure free and 24 (39%) had >50% seizure reduction. Children with daily seizures were reduced from 55% before TPM to 13% on TPM (p=0.0007). Side effects were reported in 21 (34%) children in the form of decreased appetite, weight loss, and sedation. The majority was transient; however, TPM had to be withdrawn in 7 (11%) children because of progressive weight loss or seizure worsening. Follow up renal ultrasound was performed on 34 (55%) children and was always normal. CONCLUSION: Topiramate is a very effective antiepileptic drug with a broad spectrum of antiepileptic activities. Most side effects were transient, however, careful monitoring of body weight is recommended.
ABSTRACT
OBJECTIVE: To identify high risk groups for the development of convulsive status epilepticus (CSE) in an attempt to decrease the incidence and to determine both the time to access to medical care and the use of prehospital treatment in an attempt to reduce the duration of seizing. METHODS: Retrospective study record analysis of all cases of CSE in children, at the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from June 1997 to June 2000. RESULTS: During the study period there were 24 cases of CSE. The major etiologic factors were chronic neurological disorders, idiopathic epilepsy, and acute cerebral insults. All but one of the chronic epileptics in the study group had at least one identifiable risk factor for the evolution of breakthrough seizures into status epilepticus (SE). Mortality was 12.5% and chronic neuro-behavioral morbidity in previously normal children was 17%. The average total duration of seizing was 2.3 hours, with an average of 52 minutes prior to arrival in the hospital. Prehospital rectal diazepam was administered by the family in only 2 instances, and in both cases the patients were overdosed. CONCLUSION: The identification of risk factors for CSE can serve 2 purposes: Focus targeted patient and family education, and a checklist for emergency room personnel to recognize those presenting with breakthrough seizures who are susceptible to SE, aiding in management decision making. The incidence of SE can be reduced by abbreviating the duration of breakthrough seizures. This can be achieved both by more widespread yet proper use of rectal diazepam at home, and by auditing the process of patient or family education.
