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Topiramate is a Potential Treatment Option for Children with Status Epilepticus

Topiramate treatment quickly and effectively terminates episodes of status epilepticus (SE) in children with refractory disease, say researchers.

SE is a serious and potentially life-threatening condition. Although several treatments are available, a subset of seizures remain refractory and require additional treatment. Recent studies have suggested the efficacy of topiramate in adults with refractory SE, however, its effectiveness in children has not been evaluated.

Ahmad Beydoun, MD, and colleagues at the University of Michigan Health System, Ann Arbor, United States, conducted a retrospective review of the efficacy of topiramate, a second-generation anticonvulsant drug, in 3 children with refractory SE.

The children (ages 4.5 months, 34 months, and 11 years) had not responded to previous treatment with benzodiazepines, phenytoin, phenobarbital, midazolam, or pentobarbital and were subsequently given topiramate. They were continually monitored by a 21-channel digital electroencephalograph machine.

Topiramate was administered by nasogastric tube to all 3 patients 7 to 10 days after onset of SE. Starting dose in 2 patients was 2 mg/kg/day, titrated up to 5-6 mg/kg/day over a 3-day period. The third patient received 3 mg/kg/day initially, titrated to 6 mg/kg/day over 48 hours.

Electrographic measures indicated cessation of SE in all patients within 24 hours of maintenance therapy at 5-6 mg/kg/day. Patients remained seizure-free while continuing topiramate therapy, 2 received topiramate monotherapy (100-200 mg/day) and 1 received combinatorial topiramate (50 mg/day) and phenobarbital (16 mg/day) during follow up.

No short-term adverse events were associated with topiramate treatment in these patients. Two of the 3 patients died within 1 year of discharge, 1 at 4 months and the other at 7 months.

The authors highlight that "this is the first report to suggest that topiramate is a useful option for the treatment of refractory SE in children." They further note that "although [the] results are encouraging, they can be considered only anecdotal evidence of efficacy of topiramate for children with refractory SE," and "should be confirmed by larger prospective clinical trials."

Epilepsia 2003;44:10:1353-1356. "Efficacy of topiramate in children with refractory status epilepticus"

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