Topiramate titration to response: analysis of individualized therapy study (TRAITS).
OBJECTIVE
To evaluate the relationship between baseline seizure frequency and stabilized topiramate dosage and the effect of individualized treatment on tolerability in adults with partial-onset seizures receiving other antiepileptic drugs (AEDs).


METHODS
In this 20-week, open-label trial, dosages of medications were adjusted according to clinical response. Dosage and seizure response data were analyzed for 2 groups defined by baseline seizure frequency: <4 and >/=4 seizures per month.


RESULTS
In the outcome evaluable population (n = 471), the mean +/- SEM stable topiramate dosage was 303 +/- 139 mg/d when baseline seizure frequency was <4 seizures/month and 341 +/- 153 mg/d when baseline seizure frequency was >/=4 seizures/month (p = 0.005). The most common adverse events were somnolence (8.5%), fatigue (7.3%), nausea (5.3%), and dizziness (5.0%). Cognitive complaints were reported by <3% of patients. When concomitant AED dosages were reduced, 14% of patients discontinued topiramate due to adverse events compared with 23% if the concomitant AED dosage was unchanged or increased.


CONCLUSIONS
When clinicians individualize topiramate dosage according to clinical response, the stabilized topiramate dosage as add-on therapy is influenced by baseline seizure frequency. Topiramate tolerability is improved when dosages of concomitant AEDs are reduced.
Dodson
W Edwin
WE
Department of Pediatric Neurology, School of Medicine, Washington University, St. Louis, MO 63110-1093, USA. edodson@msnotes.wustl.edu
Kamin
Marc
M
Kraut
Lesley
L
Olson
William H
WH
Wu
Shu-Chen
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy*; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose