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Topiramate Well Tolerated In Elderly, Even At High Doses: Presented at AES

By Bonnie Darves

NEW ORLEANS, LA -- December 13, 2004 -- The antiepileptic drug topiramate appears to be well tolerated in elderly patients with partial-onset seizures, and may be effective at relatively low doses, according to research presented here on December 7^th at the American Epilespy Society Annual Meeting.

Physicians who are treating newly diagnosed older patients may begin to see seizure reduction in doses of 50 mg of topiramate daily, but can safely titrate to doses as high as 200 mg daily to achieve seizure control, the study's findings suggest.

The relatively new antiepileptic has been extensively studied in young to middle-aged adults, but has not been studied in an exclusively elderly population, said lead author Eugene Ramsay, MD, Professor, Department of Neurology, Director, International Center for Epilepsy, University of Miami School of Medicine in Florida. Elderly patients with epilepsy tend to have antiepileptic tolerability profiles that differ from those of younger patients because of age-related drug absorption, metabolism and elimination factors. For this reason, researchers and treating clinicians have sought data on new antiepileptics that may be effective at lower doses than standard or older antiepileptics.

The multicenter, double-blind, controlled study included 77 patients with a mean age of 68.5 years; 38 of these patients were treated with 50 mg/day of topiramate and 39 with 200 mg/day for up to 23 weeks. The starting dose for both groups was 25 mg daily. In both groups, approximately 60% of patients took topiramate as monotherapy.

In the 50 mg monotherapy group, 29% of patients became seizure free during the study period, compared to 36% of the 200 mg group, Dr. Ramsay said.

Adverse events were surprising similar in both dose groups, he noted, with seven patients in each group discontinuing because of adverse events. Depression and ataxia were more common in patients taking the 200 mg dose. In both groups the most common adverse events, most of which were mild, were somnolence and headache.

The study was sponsored by Ortho-McNeil Pharmaceuticals, Raritan, New Jersey, United States.


[Presentation title: "A Double-Blind Study of Topiramate (TPM) Monotherapy in Older Patients With Partial-Onset Seizures." Abstract 1.332]

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