Attualita di impiego del topiramato

Topiramate (TPM) has been primarily used as add-on treatment in adult patients with refractory partial seizures following six double-blind, placebo-controlled, randomized clinical trials. The meta-analysis of these studies shows that TPM induces ≥ 50% reduction of seizures in 44% of patients, with TPM doses of 400 to 1000 mg/d being superior to placebo. In a recent large open-label pragmatic study which allowed TPM maintenance dose to be individualized to patient response, seizures were reduced ≥ 50% in 59% of patients, with 19% being seizure-free during the treatment period at TPM doses of 300-350 mg/d. The favourable results obtained in adults have been confirmed in children with refractory partial seizures treated with TPM doses of 6 to 9 mg/kg/d. TPM has been shown to be superior to placebo in well- controlled studies conducted in patients with non-focal generalized (tonic- clonic, myoclonic and tonic) seizures, Lennox-Gastaut syndrome and infantile spasms. The efficacy of TPM monotherapy has been demonstrated both in refractory and recently diagnosed partial seizures. CNS-related symptoms are the most common adverse effects induced by TPM. These events are usually mild to moderate and may cause withdrawal of TPM in the early phase of treatment. They may be attenuated or avoided by slow titration of TPM over several weeks in small increments (25 to 50 mg/d each week) and/or reduction of concomitant treatment.