TOPIRAMATE USE IN PEDIATRIC-PATIENTS

Topiramate (TPM), a new antiepileptic medication, is efficacious as ad junctive therapy in adults with partial onset seizures, Its efficacy a s adjunctive therapy in children was evaluated in two randomized doubl e-blind placebo-controlled trials involving childhood epileptic enceph alopathy (the Lennox-Gastaut syndrome) and partial onset seizures. In these studies, topiramate adjunctive therapy resulted in a significant reduction in drop attacks (tonic or atonic seizures) in patients with the Lennox-Gastaut syndrome and a significant reduction in partial on set seizures in children with refractory partial epilepsy. In both tri als, TPM's efficacy improved as the dose escalated from the double-bli nd phase to the open-label portion. The minimally effective topiramate dose for adjunctive therapy in children with refractory epilepsy appe ars to be 6 mg/kg/day. Topiramate was well tolerated with mild or mode rate side effects, predominantly related to the central nervous system . Practical tips are provided that may increase the chance that topira mate will be effective and well tolerated. The most important advice i s a ''start low. go slow'' approach. An initial TPM dose of 0.5 - I mg /kg/day followed by weekly increments of 0.5 - 1 mg/kg is usually well tolerated. Based on these studies, topiramate appeals to be an import ant addition to our pediatric AED armamentarium.