A pooled analysis of adjunctive topiramate in refractory partial epilepsy

Peeters, Karl; Adriaenssen, I; Wapenaar, Robert; Neto, Walter Krause; Pledger, Gordon

doi:10.1034/j.1600-0404.2003.00113.x

Cited by 27 publications

(34 citation statements)

References 12 publications

(41 reference statements)

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“…Doses of VPA were within the expected dose range for seizure control and emerging side effects (26). This is consistent with the broad anticonvulsant spectrum of TPM (29). Despite this, the monthly seizure rate dropped significantly between first and second visit with a further decrease at the subsequent visit for all seizure types, although more than 50% of the patients were seizure-free or had a maximum of two seizures per month during the 3-months retrospective baseline.…”

Section: Discussionsupporting

confidence: 73%

“…However, given the established efficacy of TPM and a comparative trial against VPA in newly diagnosed patients with epilepsy showing non-inferiority (22,29), it seemed reasonable to conduct a single arm study in which add-on as well as substitution of VPA with TPM is explored (31). Given the open label design, a placebo response overall is expected because of the high patient expectation switching from one AED to another.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Conversion from valproic acid onto topiramate in adolescents and adults with epilepsy

Schreiner

Stollhoff

Ossig

et al. 2009

Acta Neurologica Scandinavica

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Conversion from valproic acid onto topiramate in adolescents and adults with epilepsy

Schreiner

Stollhoff

Ossig

et al. 2009

Acta Neurologica Scandinavica

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“…In our series, drug titration was 50 mg every 10 days, i.e slower than the official recommendations or the procedures carried out during clinical trials (100-200 mg/week). However, although within the range of recent published studies (25-50 mg every 1-2 weeks) (Biraben and Genton, 2000b;Guberman et al, 2000;Peeters et al, 2003), our drug increase steps could still have been too fast. Dose-related effects occur with high-dose TPM, generally above 600 mg (Faught, 1999;Peeters et al, 2003), a dose none of our patients received.…”

Section: Second Mechanism: Direct Toxicitymentioning

confidence: 48%

Drug induced encephalopathy in six epileptic patients: topiramate? valproate? or both?

Latour

Biraben

Polard

et al. 2004

Human Psychopharmacology

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Six severe epileptic patients developed stuporous encephalopathy with marked cognitive impairment when topiramate (TPM) and sodium valproate (VPA) were coprescribed for five patients, and when monotherapy with TPM was introduced for one patient. In four patients, ammonaemia increased and then returned to normal after TPM or VPA withdrawal. This severe potential side effect must be recognized. Moreover two distinct mechanisms might explain this toxicity: (1). a pharmacokinetic interaction between VPA and TPM, leading to hyperammonaemia, (2). a pharmacodynamic mechanism due to a direct toxicity of TPM in at-risk epileptic patients.

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“…Several studies have also observed topiramate rates, and retention rates than other antiepileptic drugs. [115,116] efficacy in myoclonic seizures, infantile spasms, and refractory Responder rates in pediatric trials have reportedly ranged from partial seizures (see section 5.2). Pediatric clinical trials of topiraabout 20% to 88%, and seizure-free rates have ranged from 2% to mate are presented in table I.…”

Section: Discussionmentioning

confidence: 98%

Use of Second-Generation Antiepileptic Drugs in the Pediatric Population

Chung

Eiland

2008

Pediatric Drugs

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Epilepsy is common in the pediatric population. Nine second-generation antiepileptic drugs have been approved in the US for use in epilepsy over the past 15 years: felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, and pregabalin. Their use in pediatric patients is fairly widespread, despite most of these agents not having US FDA indications for use. Felbamate and gabapentin were the first two second-generation antiepileptic drugs to be approved in the US. Felbamate use has been limited because of the occurrence of hepatotoxicity and aplastic anemia. Although gabapentin is a fairly well tolerated antiepileptic drug, its use has also been limited as a result of inconsistent efficacy and concern about seizure exacerbation. Lamotrigine and topiramate are broad-spectrum antiepileptic drugs with efficacy in a wide variety of seizure types. Both agents have some tolerability concerns: rash with lamotrigine and neuropsychiatric events with topiramate. There are very little data on tiagabine use in children, but this agent appears to be effective and to have a good tolerability profile. Levetiracetam is a second-generation antiepileptic agent that is available intravenously. Considering its good efficacy, fast onset of action, and low incidence of serious adverse effects, its use in the acute setting could potentially increase. Oxcarbazepine and zonisamide have been relatively well studied in pediatric seizure patients, including use as monotherapy. Both agents have demonstrated good efficacy and tolerability for patients as young as 1 month old. Vigabatrin and rufinamide are currently not available in the US, but have been shown to have some success in other countries. Pregabalin is the newest antiepileptic agent, but lacks pediatric data currently.

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A pooled analysis of adjunctive topiramate in refractory partial epilepsy

Cited by 27 publications

References 12 publications

Conversion from valproic acid onto topiramate in adolescents and adults with epilepsy

Conversion from valproic acid onto topiramate in adolescents and adults with epilepsy

Drug induced encephalopathy in six epileptic patients: topiramate? valproate? or both?

Use of Second-Generation Antiepileptic Drugs in the Pediatric Population

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