These results strongly suggest that the A-allele of the MRP2 single nucleotide polymorphism c.1247G>A is associated with adverse neurological drug reactions to carbamazepine.

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SUMMARYPurpose: To evaluate the long-term efficacy and tolerability of topiramate (TPM) as add-on therapy in patients with refractory partial epilepsy. Methods: This is a retrospective, single-center, long-term observational study. Patients fulfilling the criteria of medical intractability proposed by Berg et al. were entered into the study if they were newly prescribed TPM as add-on therapy between January 2000 and June 2002. The usual starting dosage of TPM was 50 mg/day and optimal-dose adjustments were made according to individual clinical responses. Efficacy and tolerability were analyzed every year during 5-year follow-up in the ''intention-to-treat (ITT) population.'' Retention rate was estimated by Kaplan-Meyer analysis. Results: A total of 125 patients were included in the study and 107 patients (85.6%) were followed for 5 years. Retention rate was 87.2% at 1 year and 64% at 5 years. At the end of 5 years, the median seizure frequency reduction rate was 69.0% and responder rate was 43.2% in the ITT population. Cumulative seizure-free rate (SFR) was 30.4% and the terminal 1-year SFR was 12.8% in the ITT population (20.0% in completers) at 5-year follow-up. Adverse events (AEs) occurred in 39.2% of patients, including significant AEs leading to antiepileptic drug (AED) withdrawal in 14.4%. The most common AEs were anorexia (16.0%), weight loss (10.4%), and gastrointestinal symptoms (8.8%). Concomitant AEDs were reduced in 25.0% of the completers. Discussion: Low-dose and slow-dose escalation of TPM in add-on therapy for patients with refractory partial epilepsy is effective and well tolerated in long-term, individualized clinical practice. KEY WORDS: Epilepsy, Refractory, Topiramate, Efficacy, Tolerability.Topiramate (TPM) is a broad-spectrum, new-generation antiepileptic drug (AED) with multiple mechanisms of action (Perucca, 1997). The efficacy and safety of TPM as add-on therapy in adults with refractory partial epilepsies have been evaluated extensively in randomized controlled trials (RCTs) Faught et al., 1996;Privitera et al., 1996;Sharief et al., 1996;Tassinari et al., 1996; Korean Topiramate Study Group, 1999). A pooled analysis of six RCTs of TPM adjunctive therapy in adults with refractory partial seizures showed that the responder rate (RR ‡50% seizure frequency reduction) was 43%, the seizure-free rate (SFR) was 5%, and the premature withdrawal rate from the study because of adverse events (AEs) was 7% (Reife et al., 2000).RCTs of TPM adjunctive therapy have provided class 1 evidence favoring TPM over placebo; however, the clinical application of these studies is seriously limited because of inherent restrictions of regulatory trials, such as: (1) short-term duration, (2) rapid titration and fixeddosing schedules, (3) use of placebo instead of active drugs, (4) strict control of concomitant AEDs, and (5) recruitment of patients who satisfy strict inclusion criteria. To compensate for the shortage of RCTs, various pragmatic trials, including long-term observational studies, have been conducted...

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