title: Topiramate in intractable childhood onset epilepsy--a cautionary note.
abstract: OBJECTIVE
  To study the effectiveness and safety of topiramate in clinical practice, for a group of patients with childhood onset epilepsy.
  
  
  METHODS
  All patients treated with topiramate at the three study centers between November 1995 and December 31, 1997 were analyzed retrospectively, using a standardized study protocol. Data were gathered on demographic features, seizures response and medication related adverse events.
  
  
  RESULTS
  Eighty-seven patients were treated with topiramate. Over 90% seizure reduction was achieved in 8 (9%) patients, 50%-90% in 21 (24%), < 50% in 54 (62%) patients. Four patients (5%) had a deterioration in seizure control. Adverse events required topiramate discontinuation in 36 (41%). Of these 27 (31%) complained of unacceptable cognitive dulling. The rate of dose escalation and final dose in mg/kg were similar in those who remained on topiramate and those who were intolerant because of cognitive side effects.
  
  
  CONCLUSIONS
  Although topiramate resulted in > 50% seizure reduction in 29 (33%) of this group of patients with difficult epilepsy, its usefulness was limited by a high incidence of adverse effects. Adverse events prevented ongoing therapy for 36 (41%) and cognitive dulling resulted in topiramate discontinuation by 27 (31%) of the group.
authors.affiliation: Neurology Division, IWK-Grace Health Centre, Halifax, Nova Scotia, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Dooley
authors.forename: P R
authors.initials: PR
authors.lastname: Camfield
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.forename: P
authors.initials: P
authors.lastname: Langevin
authors.forename: G
authors.initials: G
authors.lastname: Ronen
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004831:Epilepsies, Myoclonic / Q000188:drug therapy; D004827:Epilepsy / Q000188:drug therapy*; D004832:Epilepsy, Absence / Q000188:drug therapy; D017029:Epilepsy, Complex Partial / Q000188:drug therapy; D004829:Epilepsy, Generalized / Q000188:drug therapy; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D000077236:Topiramate
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose