EFFICACY AND SAFETY OF TOPIRAMATE IN REFRACTORY EPILEPSY - A LONG-TERM PROSPECTIVE TRIAL

The effects of topiramate in 15 patients with drug refractory partial epilepsy or Lennox-Gastaut syndrome were assessed in an open, add-on p rospective study. After a follow-up of 14-21 months, six patients are still on topiramate (mean dosage 583 mg/day, range 400-800 mg/day), an d nine have discontinued treatment because of adverse events (n = 6), inefficacy (n = 2) or poor compliance (n = I). Nine patients (69%) con tinued to have a greater than or equal to 50% reduction in seizure fre quency during the last two months of treatment, and one has been seizu re-free for the last 19 months. The most common adverse events were so mnolence, weight loss, mental slowing, fatigue, ataxia and irritabilit y. Most of these events were reversible, but withdrawal of treatment w as required in six cases as a result of ataxia (two patients), somnole nce, metabolic acidosis, irritability or psychotic symptoms (one patie nt each). It is concluded that topiramate is a valuable agent for the long-term management of refractory epilepsy.