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Short-Term Topiramate Monotherapy Does Not Cause Sleepiness in Patients with Partial Seizures

Short-term treatment with topiramate, 200 mg/day, does not appear to impair daytime vigilance in patients newly diagnosed with partial seizures.

Daytime sleepiness has not been extensively studied in patients treated with newer antiepileptic drugs (AEDs), especially when used as monotherapy.

To clarify this issue, Enrica Bonanni, MD, with the Department of Neurosciences, Section of Neurology, University of Pisa, Italy, and colleagues assessed whether patients recently diagnosed with partial epilepsy experienced daytime sleepiness upon short-term treatment with topiramate.

The researchers determined the levels of daytime vigilance in 14 consecutive treatment-naïve patients with focal epilepsy, treated with an initial dose of 25 mg/day topiramate, slowly titrated weekly, 25 mg/day, up to 200 mg/day. The patients were compared to 14 age- and gender-matched healthy controls.

One patient reported a partial seizure during the study period and 3 patients reported 2 partial seizures each.

At the beginning of the study and 2 months later, the subjects underwent the Multiple Sleep Latency Test (MSLT), visual simple and choice reaction times (VRT), and self-rated their own degree of sleepiness with the Epworth Sleepiness Scale.

At baseline, both controls and the treatment group demonstrated similar mean daytime sleep latencies on the MSLT. Two months later, MSLT scores remained similar to baseline values.

Likewise, at baseline, subjective daytime sleepiness and VRTs were similar in controls and patients, and did not change after treatment with topiramate.

According to the researchers, in previous studies of patients with epilepsy who received add-on topiramate therapy, sleepiness was one of the most common adverse events. However, sleepiness has been reported less frequently with monotherapy.

"It is well known that sleepiness is highly related to polypharmacy, particularly with older AEDs, whereas a reduction in the number of concomitant medications is associated with a subjective increase of alertness in epilepsy patients," they add.

The researchers conclude that results of "both simple and choice visual reaction times support the findings obtained by the MSLT, showing that 200-mg daily dose of topiramate did not cause changes in patients' psychomotor performance."

Epilepsia 2004;45:333-337. "Daytime sleepiness in epilepsy patients receiving topiramate monotherapy"

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