Evolution of drug-resistant childhood epilepsy treated with topiramate

Introduction. The variable proportion of cases with childhood epilepsy resistant to treatment. has led to the development of different new drugs. Objective. To study the efficacy of topiramate as add-on therapy in the everyday practice of a neuropaediatric clinic. Patients and methods. A retrospective study of all the patients treated with topiramate in a hospital outpatient clinic was performed. Outcome measurement: I. Reduction in greater than or equal to 50% as compared to basal frequency (partial control) and total control of seizures, and 2. Duration of drug treatment, using the Kaplan-Meier method. Results. We studied 31 courses of treatment in 29 children. The aetiology of the epileptic syndromes was: idiopathic epilepsy (3.3%), cryptogenic epilepsy (58%) and symptomatic epilepsy (38.7%). We found a greater than or equal to 50% reduction in the basal monthly frequency of seizures after 3 months of treatment in 52% of the patients, which persisted 18 months later in 25%. Total control of seizures was obtained in 18.5% of the patients after 3 months of treatment, and this response was maintained IZ months later in 12.5%. The probability of maintaining treatment with topiramate for 6 months was 80%, and for 12 months was 49%. The average duration of treatment was 7.9 months (interval 1-29 months). Topiramate was suspended in 9 patients (29%). Conclusion. In difficult to treat childhood epilepsy topiramate as add-on therapy provides a partial and total responses which are similar to those reported with classical drugs, and depend on the duration of follow-up.