Topiramate on ictal seizure semiology: a quantitative, randomized, low andmedium dose-controlled study

Objective: Intensive and quantitative evaluation of the severity and freque ncy of seizures and ictal signs during topiramate (TPM) treatment. Methods: Twenty patients with refractory partial seizures undergoing presurgical ev aluation were randomized into a low dosage (100 mg daily) and a parallel me dium dosage (200 mg daily) group of TPM add-on medication. Study phases inc luded a 3-day baseline video-EEG phase, a 10-day TPM titration phase withou t video-EEG and a 3-day TPM dose maintenance phase with video-EEG. During t he baseline and the dose maintenance phase seizures were recorded using vid eo-EEG monitoring and the following parameters were measured: duration (las ting seconds of each seizure and ictal sign), intensity (on a 0-3 scale), N /24 h (numbers of attacks per 24 h). D/24 h (duration per 24 h) of both sei zures and defined ictal signs. Results: A total of 399 seizures during the baseline phase and the dose maintenance phase were intensively analyzed. In tergroup comparison suggested that duration, N/24 h and D/24 h of all seizu res decreased more in the medium dosage group computing the reduction from baseline to the dose maintenance phase (P < 0.05). There were statistically more significant reductions in the duration, intensity and N/24 h of ictal signs like hypermotoric movements, fumbling and vocalization in the medium dosage group (P < 0.05). Conclusion: Topiramate has an early dose-dependan t effect on ictal seizures. Short Communication: The present study intensiv ely analyzed the duration, intensity, N/24 h and D/24 h of ictal seizure ma nifestations. The quantitative data suggested that topiramate had an early effect on ictal phenomena like ictal hypermotoric movements, fumbling and v ocalization (P < 0.05); effects were more prominent in the medium dosage gr oup (200 mg daily) than the low dosage group (100 mg daily). (C) 2001 Elsev ier Science B.V. All rights reserved.