title: Infantile Spasms Respond Poorly to Topiramate.
abstract: BACKGROUND
  Infantile spasms are seizures typical of an age-related epileptic encephalopathy. Although evidence supporting topiramate for infantile spasms is lacking, many clinicians use it for this indication. The aim of this study was to determine the rate of infantile spasm remission with topiramate at our institution. A low rate of infantile spasm remission was hypothesized.
  
  
  METHODS
  This was a single-center retrospective medical record review of patients treated with topiramate for infantile spasms between January 2009 and September 2013. Records were reviewed for accuracy of diagnosis and outcome. Clinical remission of infantile spasms was defined as resolution for at least 28 days at any time during treatment with topiramate. For patients with clinical remission, posttreatment electroencephalographs were reviewed to assess for electrographic remission. To assess for confounding variables affecting remission rate, demographics and outcomes were compared with patients treated with adrenocorticotropic hormone within the same period using the same criteria for remission.
  
  
  RESULTS
  Three of 31 (9.7%) patients achieved clinical remission with topiramate, two of whom also experienced electrographic remission. The third patient had electrographic remission with previous adrenocorticotropic hormone treatment but infantile spasm remission only after receiving topiramate. All three of these patients experienced subsequent electroclinical relapse during topiramate therapy. Although there were no significant demographic differences between the topiramate and adrenocorticotropic hormone cohorts, more adrenocorticotropic hormone patients achieved clinical remission (9.7% versus 56%; P < 0.001).
  
  
  CONCLUSIONS
  Remission of infantile spasms with topiramate was uncommon and no patient experienced persistent electroclinical remission. These findings suggest that infantile spasms respond poorly to topiramate.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
authors.forename: Amanda
authors.initials: A
authors.lastname: Weber
authors.affiliation: Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Cole
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio. Electronic address: john.mytinger@nationwidechildrens.org.
authors.forename: John R
authors.initials: JR
authors.lastname: Mytinger
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000188:drug therapy*; D000077236:Topiramate; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D000324:Adrenocorticotropic Hormone
keywords: West syndrome; epilepsy; infantile spasms; pediatric; topiramate