title: Treatment of refractory generalized convulsive status epilepticus with enteral topiramate in resource limited settings.
abstract: OBJECTIVE
  To explore the feasibility, safety and efficacy of enterally administered topiramate (TPM) as an adjunctive treatment for adult patients with refractory generalized convulsive status epilepticus (RGCSE).
  
  
  METHODS
  This prospective open-label non-randomized clinical trial was performed at Namazee hospital, Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 through February 2014. Patients 18 years of age and older with RGCSE were enrolled. Topiramate was used, in case of failure of at least two standard anti-epileptic drugs in patients in whom the standard third or fourth line therapies were not available. Topiramate tablets were crushed and administered through the nasogastric tube; 400mg stat and then 200mg Bid. Status epilepticus response to TPM was categorized as successful (termination of SE within 24h following TPM introduction, without modification of concomitant AEDs), possible (SE termination associated with the introduction of TPM, concomitantly with other medications) or unsuccessful.
  
  
  RESULTS
  Twenty patients were studied. Topiramate was successful in terminating SE in five (25%) patients; possibly successful in 11 (55%); and not successful in four (20%). No clinically significant adverse effects related to TPM administration were observed. Eleven (55%) patients returned to their baseline clinical condition at the time of discharge from the hospital, but two (10%) patients did not.
  
  
  CONCLUSIONS
  Treatment with enterally administered topiramate could potentially be efficacious in some patients and appeared to be tolerated well in patients with RGCSE. Low cost and feasibility makes TPM a potentially useful agent in treating patients with RGCSE, especially in resource limited settings.
authors.affiliation: Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA. Electronic address: aliasadipooya@yahoo.com.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Asadi-Pooya
authors.affiliation: Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Maryam Jalali
authors.initials: MJ
authors.lastname: Jahromi
authors.affiliation: Department of Neurology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Izadi
authors.affiliation: Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Yasaman
authors.initials: Y
authors.lastname: Emami
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D004569:Electroencephalography; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D000077236:Topiramate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose
keywords: Adults; Adverse-effects; Status Epilepticus; Topiramate