FOCUS ON TOPIRAMATE - A 2ND-GENERATION ANTIEPILEPTIC AGENT FOR TREATMENT OF REFRACTORY EPILEPSY

Topiramate is a novel antiepileptic drug (AED) that recently received FDA approval. This sulfamate-substituted monosaccharide is structurall y unique from other AEDs. It acts primarily by blocking the spread of seizures rather than by elevating the seizure threshold. Topiramate is indicated for use as adjunctive treatment in adults with refractory p artial-onset epilepsy. Clinical trials have demonstrated superior safe ty, efficacy, and tolerability when topiramate is initiated at low dos es and slowly titrated to 400 mg/day in two divided doses. Advantages of topiramate compared with traditional antiepileptic agents include f irst-order elimination, low plasma protein binding, and infrequent dru g-drug interactions. Topiramate is a promising new addition to a growi ng spectrum of agents available to treat refractory seizure disorders.