Prospective Study of First-choice Topiramate Therapy in Newly Diagnosed Infantile Spasms

Zou, Li‐Ping; Ding, Chunmei; Fang, Fang; Sin, Ngai-chuen; Mix, Eilhard

doi:10.1097/01.wnf.0000236768.54150.8c

Cited by 14 publications

(10 citation statements)

References 25 publications

(28 reference statements)

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“…The mean dosage of TPM applied in our study was relatively low compared with other reports conducted with the low dosages18,26,27) as well as high14). There was a study, however, which concluded that the mean dosage during stabilization was 5.2 mg/kg/day similar to that of our study17). In the other study30), a wide range of TPM dosage (ranges from 1.3 to 35 mg/kg/day) was reported and some patients who responded in 1 month or less did so at very low doses, 1.3 and 3.4 mg/kg/day.…”

Section: Discussionsupporting

confidence: 77%

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Short term outcomes of topiramate monotherapy as a first-line treatment in newly diagnosed West syndrome

Lee

et al. 2011

Korean J Pediatr

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PurposeTo investigate the efficacy of topiramate monotherapy in West syndrome prospectively.MethodsThe study population included 28 patients (15 male and 13 female children aged 2 to 18 months) diagnosed with West syndrome. After a 2-week baseline period for documentation of the frequency of spasms, topiramate was initiated at 2 mg/kg/day. The dose was increased by 2 mg/kg every week to a maximum of 12 mg/kg/day. Clinical assessment was based on the parents' report and a neurological examination every 2 weeks for the first 2 months of treatment. The baseline electroencephalograms (EEGs) were compared with the post-treatment EEGs at 2 weeks and 1 month.ResultsWest syndrome was considered to be cryptogenic in 7 of the 28 patients and symptomatic in 21 patients. After treatment, 11 patients (39%) became spasm-free, 6 (21%) had more than 50% spasmsreduction, 3 (11%) showed less than 50% reduction, and 8 (29%) did not respond. The effective daily dose for achieving more than 50% reduction in spasm frequency, including becoming spasm-free, was found to be 5.8±1.1 mg/kg/day. Nine patients (32%) showed complete disappearance of spasms and hypsarrhythmia, and 11 (39%) showed improved EEG results. Despite adverse events (4 instances of irritability, 3 of drowsiness, and 1 of decreased feeding), no patients discontinued the medication.ConclusionTopiramate monotherapy seems to be effective and well tolerated as a first line therapy for West syndrome and is not associated with serious adverse effects.

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Section: Discussionsupporting

confidence: 77%

“…Other studies have treated patients with multiple antiepileptic drugs concurrently with TPM17). But only a few studies suggested that TPM can be a first-line drug and can be used as monotherapy18,19).…”

Section: Introductionmentioning

confidence: 99%

Short term outcomes of topiramate monotherapy as a first-line treatment in newly diagnosed West syndrome

Lee

et al. 2011

Korean J Pediatr

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“…As a result of limited options with significant toxicity, researchers have actively investigated second‐generation anticonvulsants possessing relatively fewer side effects, including felbamate (Hosain et al, 1997), levetiracetam (Lawlor & Devlin, 2005), topiramate (Hosain et al, 2006; Zou et al, 2006), and zonisamide (Lotze & Wilfong, 2004). However, none of these drugs have demonstrated spasm‐free outcomes similar to ACTH, and often have been used primarily for refractory spasms (Mackay et al, 2004).…”

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confidence: 99%

A case‐control evaluation of the ketogenic diet versus ACTH for new‐onset infantile spasms

et al. 2008

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SUMMARYPurpose: ACTH is currently the standard first-line therapy for new-onset infantile spasms, but it has significant side effects. We hypothesized the ketogenic diet (KD), previously reported as beneficial for intractable infantile spasms, would have similar efficacy, but better tolerability than ACTH when used first-line. Methods: We conducted a retrospective chart review of all infants started on the KD (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at our institution since 1996. Results: Infants were spasm-free in 8 of 13 (62%) infants treated with the KD within 1 month, compared to 18 of 20 (90%) treated initially with ACTH, p = 0.06. When effective, median time to spasm freedom was similar between ACTH and the KD (4.0 vs. 6.5 days, p = 0.18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53% vs. 9%, p = 0.02), however, use of the KD led to EEG normalization within 2-5 months in all eight who became spasm-free. In the five children in whom the KD was unsuccessful, four became spasm-free subsequently with ACTH or topiramate immediately. Side effects (31% vs. 80%, p = 0.006) and relapse rate after initial success (12.5% vs. 33%, p = 0.23) were lower with the KD. Discussion: In this retrospective study, the KD stopped spasms in nearly two-thirds of cases, and had fewer side effects and relapses than ACTH. ACTH normalized the EEG more rapidly, however. Further prospective study of the KD as, with a 2-week time limit if unsuccesful, first-line therapy for infantile spasms is warranted.

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“…TPM has been very effective in treating childhood forms of epilepsy, including Lennox–Gastaut syndrome, juvenile myoclonic epilepsy (Mikaeloff et al 2003; Glauser et al 2007; Malphrus and Wilfong 2007), infantile spasms (Valencia et al 2005; Zou et al 2006), and West syndrome (Korinthenberg and Schreiner 2007). Generally, it has been well tolerated in children, and doses on a mg‐per‐kg body weight basis have often exceeded those of adults (Valencia et al 2005; Zou et al 2006; Glouser et al 2007), possibly because of a more rapid elimination rate in children than in adults (Adin et al 2004). TPM is approved for therapy in children as young as 2 years of age, but some clinical studies in younger children have been described (Valencia et al 2005; Zou et al 2006).…”

Section: Pharmacodynamics Related To Adverse Clinical Effectsmentioning

confidence: 99%

Molecular Pharmacodynamics, Clinical Therapeutics, and Pharmacokinetics of Topiramate

Shank

Maryanoff

2008

CNS Neuroscience & Therapeutics

124

122

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Topiramate (TPM; TOPAMAX®) is a broad‐spectrum antiepileptic drug (AED) that is approved in many world markets for preventing or reducing the frequency of epileptic seizures (as monotherapy or adjunctive therapy), and for the prophylaxis of migraine. TPM, a sulfamate derivative of the naturally occurring sugar D‐fructose, possesses several pharmacodynamic properties that may contribute to its clinically useful attributes, and to its observed adverse effects. The sulfamate moiety is essential, but not sufficient, for its pharmacodynamic properties. In this review, we discuss the known pharmacodynamic and pharmacokinetic properties of TPM, as well as its various clinically beneficial and adverse effects.

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Prospective Study of First-choice Topiramate Therapy in Newly Diagnosed Infantile Spasms

Abstract: Topiramate proves to be an effective and safe first-choice drug not only as adjunctive but also as monotherapy of infantile spasms in children younger than 2 years.

Cited by 14 publications

References 25 publications

Short term outcomes of topiramate monotherapy as a first-line treatment in newly diagnosed West syndrome

Short term outcomes of topiramate monotherapy as a first-line treatment in newly diagnosed West syndrome

A case‐control evaluation of the ketogenic diet versus ACTH for new‐onset infantile spasms

Molecular Pharmacodynamics, Clinical Therapeutics, and Pharmacokinetics of Topiramate

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