Summary:Purpose: Status epilepticus (SE) is a life-threatening medical condition associated with significant morbidity and mortality that requires urgent medical intervention. Although several agents are available to treat SE, they occasionally fail to abort seizure activity. Topiramate (TPM) was anecdotally reported to be effective in adult patients with refractory SE. In this study, we evaluated the efficacy of TPM administered to children with this condition.Methods: We retrospectively reviewed the pediatric SE database at the University of Michigan Medical Center and identified three children with refractory SE who were treated with TPM. Those children failed to respond to treatment with benzodiazepines, phenytoin, phenobarbital, midazolam, or pentobarbital. Additional treatment with TPM was administered by nasogastric tube. All patients were continuously monitored by 21-channel digital EEG machines, and the diagnosis of SE was made by a board-certified neurophysiologist.Results: The ages of the three children were 4.5 months, 34 months, and 11 years. TPM was initiated at 2 mg/kg/day in two children and at 3 mg/kg/day in the third. The status was terminated in all three children within 24 h of maintenance therapy with TPM at 5-6 mg/kg/day.Conclusions: These results support the potential efficacy of TPM for children with refractory SE. Larger prospective series are needed to confirm those results. Key Words: TopiramateSafety-Status epilepticus-Efficacy-Antiepileptic drugs.Status epilepticus (SE) in childhood is a serious and potentially life-threatening medical condition that requires immediate medical intervention (1). It is estimated that 0.4-0.8% of children will experience an episode of convulsive SE before age 15 years (2). Various treatment protocols have been advocated to treat SE in children including benzodiazepines (BZDs), phenytoin (PHT)/fosphenytoin (FOS), barbiturates, paraldehyde, and general anesthesia (3). Although these agents are usually successful in terminating seizure activity, some seizures remain refractory and require additional intervention. Refractory SE has been defined as seizures lasting >60 min despite treatment with BZDs and an adequate intravenous loading dose of a standard anticonvulsant drug (AED) (4) or the persistence of seizure activity despite appropriate medical and AED therapy (5). Refractory SE in childhood was shown to be associated with a high morbidity and a mortality rate of ≤32% (6).Topiramate (TPM) is a second-generation AED with multiple mechanisms of action including blockade of voltage-sensitive Na + and L-type Ca 2+ channels, enAccepted June 25, 2003. Address correspondence and reprint requests to Dr. A. Beydoun at University of Michigan Health System, 1500 E. Medical Center Drive, UH1B300/0036, Ann Arbor, MI 48109-0036, U.S.A. E-mail: beydoun@umich.edu hancement of γ -aminobutyric acid (GABA) activity at GABA A receptors, inhibition of kainate-evoked currents, and inhibition of certain carbonic anhydrase isozymes (7). It was recently reported to be beneficia...

SMART is associated with reduced health complications and improved mood, quality of life, and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up.

Consistent with previous literature, more frequent seizures were associated with worse depression severity and quality of life. A finding that is less established is that higher seizure frequency is also associated with worse epilepsy-related stigma. Epilepsy self-management approaches need to address depression and stigma as well as seizure control.