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Low‐dose topiramate in adults with treatment‐resistant partial‐onset seizures
Author(s) -
Guberman A.,
Neto W.,
GassmannMayer C.
Publication year - 2002
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1034/j.1600-0404.2002.02071.x
Subject(s) - topiramate , tolerability , medicine , adverse effect , placebo , anesthesia , anticonvulsant , carbamazepine , randomized controlled trial , adjunctive treatment , pediatrics , epilepsy , psychiatry , alternative medicine , pathology
Objectives – Based on dose predictions from animal and human volunteer studies, most patients enrolled in initial randomized controlled trials of topiramate as adjunctive therapy in adults with partial‐onset seizures were randomized to ≥ 600 mg/day topiramate. Subsequent experience suggests that dosage needs were overestimated. This double‐blind, placebo‐controlled study evaluated 200 mg/day topiramate in adults with treatment‐resistant partial‐onset seizures receiving a concurrent enzyme‐inducing antiepileptic agent (carbamazepine). Material and methods – After a 4‐week baseline, 263 adults receiving carbamazepine who had at least three partial‐onset seizures during the baseline period were randomized to placebo or one of two topiramate 200 mg/day treatment arms: topiramate escalated weekly 25 mg/day(8‐week escalation) or 50 mg/day(4‐week escalation). Therapy was then maintained for the remainder of the 12‐week double‐blind study. Results – Median percent reduction in seizure frequency from baseline to study end was 44% with topiramate and 20% with placebo ( P ≤ 0.001). A significant therapeutic effect was present at 2 weeks with a dose of 100 mg/day. The most common adverse events (≥10% incidence in topiramate‐treated patients) were somnolence, fatigue, paresthesia, nervousness and anorexia; 8% of topiramate‐treated patients and 2% of placebo‐treated patients discontinued because of adverse events. As a result of the low incidence of adverse events, differences between titration rates in terms of tolerability were not detected. Conclusion – Topiramate 200 mg/day is an appropriate target dose as adjunctive therapy in adults with treatment‐resistant partial‐onset seizures, even when receiving an enzyme‐inducing agent; 100 mg/day also appears to be effective. A significant therapeutic effect may be seen in the second week of treatment with a dose of 100 mg/day.