Long-term response to topiramate in patients with West syndrome

Purpose: The long-term effectiveness of topiramate (TPM) was evaluated in c hildren with West syndrome previously refractory to antiepileptic drug (AED ) therapy. Methods: Children with infantile spasms who completed a pilot study were el igible to enter a long-term extension phase in which the dosages of TPM and other AEDs could be adjusted to optimal response (maximum, 50 mg/kg/day TP M). The mean duration of long-term therapy was 18 months in the 11 children who were followed; the mean TPM dosage was 29 mg/kg/day. Results: Eight (73%) children were continuing TPM therapy at the time data were analyzed; four (50%) children were spasm free, seven (88%) had experie nced a greater than or equal to 50% reduction in spasms, and three (38%) we re able to achieve TPM monotherapy. Conclusions: TPM was well tolerated in that no patients discontinued becaus e of adverse events. The response achieved with TPM during the pilot study was maintained in most children.