title: Topiramate titration to response: analysis of individualized therapy study (TRAITS).
abstract: 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.
authors.affiliation: Department of Pediatric Neurology, School of Medicine, Washington University, St. Louis, MO 63110-1093, USA. edodson@msnotes.wustl.edu
authors.forename: W Edwin
authors.initials: WE
authors.lastname: Dodson
authors.forename: Marc
authors.initials: M
authors.lastname: Kamin
authors.forename: Lesley
authors.initials: L
authors.lastname: Kraut
authors.forename: William H
authors.initials: WH
authors.lastname: Olson
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Wu
mesh_terms: 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
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose