title: Topiramate in childhood epileptic encephalopathy with continuous spike-waves during sleep: A retrospective study of 21 cases.
abstract: OBJECTIVE
  Encephalopathy with continuous spike-wave during sleep (CSWS) is a particularly difficult-to-treat childhood epileptic syndrome. This study sought to present the EEG improvement and clinical efficacy of topiramate (TPM), a broad spectrum antiepileptic drug (AED), in a series of 21 children with CSWS encephalopathy.
  
  
  METHODS
  We retrospectively reviewed the EEG results and clinical data of children with CSWS followed-up in our institution and treated with TPM. Sleep EEGs were performed 0-3 months prior to TPM introduction and then at 3 and 12 months. The exclusion criteria were (1) introduction of another AED and (2) withdrawal of a potentially aggravating AED during the first 3 months of treatment. In addition to spike index (SI), the severity of EEG abnormalities was rated using an original scale that also considered the spatial extent of interictal epileptiform discharges.
  
  
  RESULTS
  21 patients were included (18 males, 4-14y, three symptomatic cases). At 3 months, sleep EEG was improved in 14 and normalized in four (TPM doses: 2-5.5 mg/kg/day). Among these 18 patients, 16 manifested cognitive or behavioural improvement. In a subgroup of seven patients with frequent seizures, five became seizure-free and one had over 75% decrease in seizure frequency. At the one-year follow-up, 20 children were still on TPM and 10 exhibited persistent EEG improvement without any other AED being introduced, most of them with clinical benefits.
  
  
  CONCLUSIONS
  TPM can decrease EEG abnormalities in epileptic encephalopathy with CSWS, achieving clinical improvement in the majority of patients. However, relapse may occur in the long-term in nearly half of cases. Otherwise, TPM has proven particularly useful in reducing seizure frequency in refractory cases.
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium. Electronic address: pascal.vrielynck@cnwl.be.
authors.forename: P
authors.initials: P
authors.lastname: Vrielynck
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Marique
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Ghariani
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Lienard
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: de Borchgrave
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: van Rijckevorsel
authors.affiliation: William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy, Université Catholique de Louvain, Ottignies, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Bonnier
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D013036:Spasms, Infantile / Q000188:drug therapy* / Q000503:physiopathology*; D000077236:Topiramate
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose
keywords: CSWS; Childhood; ESES; Epilepsy; Topiramate