Clinical experience with open-label topiramate use in epileptic children with CNS anomalies

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Purpose: To investigate the effectiveness and tolerability of topiramate (TPM) in treating children with CNS anomalies and intractable epilepsy.Methods: We retrospectively searched the patient database in National Taiwan University Hospital for candidate children (younger than 18 years of age) with epilepsy and CNS anomalies from December 2002 to February 2004. The effectiveness and possible side effects of TPM were evaluated by questionnaire.Results: Twenty-two children (9 males, 13 females) aged from five months to fourteen years were enrolled in the present study. Underlying CNS anomalies were proliferation disorders (n=10), migration/organization disorders (n=10), and neurocutaneous syndromes (n=2). Types of epilepsy at TPM add-on were symptomatic partial epilepsy (n=11), infantile spasms (n=7), and Lennox-Gastaut syndrome (n=4). During the follow-up periods of six to 30 months, eight patients (36%) had more than 50% reduction of seizures and four patients (18%) were seizure-free. The average dosages of TPM ranged from 2.5 to 25 mg⁄kg⁄day. Patients with proliferation disorders or infantile spasms responded better to TPM therapy. The most common side effect was oligohidrosis (n=9, 41%).Conclusion: TPM is a safe and promising add-on anticonvulsant for epileptic children with CNS anomalies. Hypohidrosis is one of the major side effects of TPM treatment.