Use in Pediatric Patients
Topiramate (TPM), a new antiepileptic medication, is efficacious
as adjunctive therapy in adults with partial onset seizures.
Its efficacy as adjunctive therapy in children was evaluated
in two randomized double-blind placebo-controlled trials involving
childhood epileptic encephalopathy (the Lennox-Gastaut syndrome)
and partial onset seizures. In these studies, topiramate adjunctive
therapy resulted in a significant reduction in drop attacks
(tonic or atonic seizures) in patients with the Lennox Gastaut
syndrome and a significant reduction in partial onset seizures
in children with refractory partial epilepsy. In both trials,
TPM's efficacy improved as the dose escalated from the double-blind
phase to the open-label portion. The minimally effective topiramate
dose for adjunctive therapy in children with refractory epilepsy
appears to be 6 mg/kg/day. Topiramate was well tolerated with
mild or moderate side effects, predominantly related to the
central nervous system. Practical tips are provided that may
increase the chance that topiramate will be effective and well
tolerated. The most important advice is a "start low, go slow"
approach. An initial TPM dose of 0.5 - 1 mg/kg/day followed
by weekly increments of 0.5 - 1 mg/kg is usually well tolerated.
Based on these studies, topiramate appears to be an important
addition to our pediatric AED armamentarium.
J. Neurol. Sci. 1998; 25: S8-S12