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Topiramate in Patients with Learning Disability and Refractory Epilepsy
Author(s) -
Kelly Kevin,
Stephen Linda J.,
Sills Graeme J.,
Brodie Martin J.
Publication year - 2002
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2002.47401.x
Subject(s) - topiramate , epilepsy , refractory (planetary science) , clinical neurology , medicine , learning disability , psychology , pediatrics , psychiatry , neuroscience , physics , astrobiology
Summary: Purpose: Management of seizures in learning disabled people is challenging. This prospective study explored the efficacy and tolerability of adjunctive topiramate (TPM) in patients with learning disability and refractory epilepsy attending a single centre. Methods: Sixty‐four patients (36 men, 28 women, aged 16–65 years) were begun on adjunctive TPM after a 3‐month prospective baseline on unchanged medication. Efficacy end points were reached when a consistent response was achieved over a 6‐month period at optimal TPM dosing. These were seizure freedom or ≥50% seizure reduction (responder). Appetite, behaviour, alertness, and sleep were assessed by caregivers throughout the study. Results: Sixteen (25%) patients became seizure free with adjunctive TPM. There were 29 (45%) responders. A further 10 (16%) patients experiencing a more modest improvement in seizure control continued on treatment at the behest of their family and/or caregivers. TPM was discontinued in the remaining nine (14%) patients, mainly because of side effects. Final TPM doses and plasma concentrations varied widely among the efficacy outcome groups. Many patients responding well to adjunctive TPM did so on ≤200 mg daily. Mean carer scores did not worsen with TPM therapy. Conclusions: TPM was effective as add‐on therapy in learning‐disabled people with difficult‐to‐control epilepsy. Seizure freedom is a realistic goal in this population.