Efficacy of Topiramate in Children with Refractory Status Epilepticus

• Published in: Epilepsia (Copenhagen) Vol. 44; no. 10; pp. 1353 - 1356
• Main Authors: Kahriman, Mustafa, Minecan, Daniela, Kutluay, Ekrem, Selwa, Linda, Beydoun, Ahmad
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA Blackwell Science Inc 01-10-2003; Blackwell
• Subjects: Anticonvulsants. Antiepileptics. Antiparkinson agents; Antiepileptic drugs; Biological and medical sciences; Child; Child, Preschool; Efficacy; Female; Fructose - analogs & derivatives; Fructose - therapeutic use; Humans; Infant; Male; Medical sciences; Neuropharmacology; Pharmacology. Drug treatments; Retrospective Studies; Safety; Status epilepticus; Status Epilepticus - drug therapy; Status Epilepticus - physiopathology; Topiramate; Human; Topiramate; Nervous system diseases; Prognosis; Indication; Epilepsy; Adjuvant treatment; Male; Infant; Anticonvulsant; Electroencephalography; Topiramate- Safety-Status-epilepticus-Efficacy-Antiepileptic drugs; Cerebral disorder; Case study; Refractory; Electrodiagnosis; Chemotherapy; Central nervous system disease; Female; Child; Status epilepticus
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1046/j.1528-1157.2003.11803.x

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.