The clinical efficacy of topiramate in the treatment of epilepsy

Topiramate, a novel antiepileptic drug, has been investigated for the treat ment of seizures which have proved resistant to other medications. In the m ajority of studies it has been used adjunctively with existing treatments; whilst evidence is accruing relating to its use as monotherapy, topiramate is at present licenced only as add-on medication. Information on the clinic al profile of topiramate is presently available from a wide range of open-l abel studies and double-blind, placebo-controlled trials. In both children and adults, topiramate has been shown to be effective in the treatment of r efractory partial-onset seizures, with or without secondarily generalized s eizures, and in refractory primary generalized tonic-clonic seizures. Effic acy is maintained over extended treatment periods in a high proportion of p atients. In children, topiramate also has therapeutic efficacy against Lenn ox-Gastaut syndrome. The findings of clinical trials on this agent are robu st over a range of criteria of clinical response, and identical conclusions are reached on the basis of analyses conducted on trial completers and on an intention-to-treat basis. It is concluded that topiramate represents an important addition to the range of antiepileptic medications currently avai lable, and that its use is indicated when a patient's epileptic seizures pr ove resistant to one or more other treatments.