A pilot study of topiramate in the treatment of infantile spasms.
OBJECTIVE
West syndrome is a rare epileptic syndrome associated with infantile spasms, a specific abnormal electroencephalographic pattern (termed hypsarrhythmia), and mental retardation. Management of this disorder is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. Topiramate (TPM) is a new antiepileptic drug that may be effective in pediatric epilepsies. We conducted a pilot study to test the effects of rapid TPM dosing in patients with refractory infantile spasms.


METHODS
Eleven children with refractory infantile spasms were given an initial dose of 25 mg TPM per day in addition to their current therapy. Dosage was increased by 25 mg every 2-3 days until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 24 mg/kg/day was achieved. Efficacy was primarily assessed by video EEG and secondarily by parental count of spasm frequency.


RESULTS
Five (45%) subjects became spasm free during the study, with absence of infantile spasms and hypsarrhythmia (either classic or modified) proven by video EEG. Nine subjects, including the five spasm free, achieved a spasm reduction of > or =50%. Spasm frequency decreased from 25.6+/-19.3 to 6.9+/-5.9 spasms/day. Sixty-four percent of the subjects were able to achieve TPM monotherapy.


CONCLUSIONS
Results in this cohort of 11 patients with refractory disease show TPM to be a promising new agent for the treatment of infantile spasms.
Glauser
T A
TA
Comprehensive Epilepsy Program, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Clark
P O
PO
Strawsburg
R
R
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D013036:Spasms, Infantile / Q000188:drug therapy*; D000077236:Topiramate; D016896:Treatment Outcome; D014743:Videotape Recording
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose