The Effect of Topiramate in Treatment of Children with Intractable Epilepsy

Document Type : Research Paper




ntroduction: 0.5 to 1% of children are epileptic, and 25% of these patients are resistant to therapy. Uncontrolled seizures produce multiple impairments in personal and social life of the patient. Any reduction in seizure number or obviation of them will raise quality of life and can refine educational, occupational and familial situation of the patient. Multiple studies in adults and children have shown efficacy of topiramate as mono or add-on therapy in reduction of seizures. The aim of this study was to evaluate the effects of this drug on intractable epilepsy.
Material and Methods: This study was done as a clinical trial in Pediatric Neurology Clinic of Ghaem Hospital in the year 2005. 24 drug resistant epileptic patients entered the study. In all of them topiramate administered as add-on therapy in a daily dose of 3 mg/kg and increased up to 9 mg/kg, in a therapy period of at least two months. Any change in seizure number, probable side effects of drug consumption, and patients individual data was evaluated and recorded in a questionnaire and analyzed by descriptive statistics and frequency distribution tables.
Result: Mean of seizure number of patients was 119.95 per month, which reduced to 53.41 after recieving topiramate. In 25% of patients seizures resolved completely and in 20.9% of them no improvement was noted. The results of this study implied the efficacy of topiramate in reduction of seizure number.
Conclusion: Topiramate and other new antiepileptic drugs due to their effectiveness and lesser adverse effects can be used progressively, and in many cases they can be substituted for older antiepileptic agents.


1- Bleasel A, Wyllie E. Paroxysmal disorders. In: Practical strategies in pediatric diagnosis and therapy.2nd ed.
Philadelphia:Elsevier Saunders; 2004.673-704.
2- Shorvon S, Perucca E, Fish D, Dodson E. The treatment of epilepsy. 2nded. Oxford: Blackwell ; 2003.535-
3- Easterling D,Zakszewski T,Moyer M,Margul B,Marriot T,Nayak R.Plasma pharmacokinetics of topiramate,a
new anticonvulsant in humans.Epilepsia 1988;29:662.
4- Nayak R,Gisclon L,Curtin C,Benet L.Estimation of the absolute bioavailability of topiramate in humans without
intravenous data.J Clin Pharmacol 1994;34:1029.
5- Doose D,Walker SA,Gisclon L,Nayak R.Single dose pharmacokinetics and effect of food on the bioavailability
of topiramate,a novel antiepileptic drug. J Clin Pharmacol 1996; 36:884-91.
6- Wu W,Heebner J,Streeter A et al.Evaluation of the absorption,excretion, pharmacokinetics and metabolism of
the anticonvulsant, topiramate in healthy men.Pharm res 1994;11 (suppl.):s336.
7- Glauser T,Miles M,Tang P et al.Topiramate pharmacokinetics in infants. . Epilepsia 1999; 40:788-91.
8- Shorven S .D.Safety of topiramate:adverse events andrelationships to dosing. Epilepsia 1996; 37:S18-S22.
9- Sachdeo RC, Reife RA, Lim P, Pledger G.Topiramate monotherapy for partial onset seizures. Epilepsia 1997;
10- Jayawant S, Libretto SE. Topiramate in the treatment of Myoclonic-Astatic epilepsy in children: a retrospective
hospital audit. J Postgrad Med 2003; 49(3):202-206.
11- Ferrari AR, Guerrini R, Gatti G, Alessandri MG, Pharm B, Bonanni P, Perucca E. Influence of dosage, age, and
co-medication on plasma Topiramate concentrations in children and adults with severe epilepsy and preliminary
observations on correlations with clinical response.Therap Drug Monit 2003; 25(6):700-708.
12- Bootsma HPR, Coolen F, Aldenkamp AP, Arends J, Diepman L, et al. Topiramate in clinical practice: Long
term experience in patients with refractory epilepsy referred to a tertiary epilepsy center. Epilepsy & Behavior 2004;
13- Aykutlu E, Baykan B, Gürses C, Bebek N, et al. Add-on therapy with Topiramate in progressive myoclonic
epilepsy. Epilepsy & Behavior 2005; 6:260-263.
14- Grosso S, Galimberti D, Farnetani MA, Cioni M, et al.Efficacy and safety of Topiramate in infants according to
epilepsy syndromes. Seizure 2005; 14:183-189.
15- AL Ajlouni S, Shorman A, Daoud AS. The efficacy and side effects of Topiramate on refractory epilepsy in
infants and young children: A multi-center clinical trial. Seizure 2005; 14:459-463.
16- Giannakodimos St, Georgiadis G, Tsounis St, Triantafillou N, et al . Add-on Topiramate in the treatment of
refracyory partial-onset epilepsy: Clinical experience of outpatient epilepsy clinics from 11 general hospitals.
Seizure 2005; 14:396-402. et a
17- Placidi F, Tombini M, Romigi A, Bianchi L et al .Topiramate: effect on EEG interictal abnormalities and
background activity in patients affected by focal epilepsy. Epilepsy Research 2004; 58:43-52.