Topiramate Monotherapy in Infantile Spasm

초록

Purpose: Infantile spasm is an age-related refractory epilepsy. Topiramate(TPM) is a new anticonvulsant with multiple action mechanisms that may be effective in intractable epilepsies. We evaluate the efficacy and tolerability of first-line TPM treatment for newly diagnosed patients with infantile spasm. Methods: TPM was given at a dose of 1 mg/kg per day, with a progressive titration of 1 mg/kg a week until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 12 mg/kg/day was achieved. Effectiveness was evaluated by scalp EEG and by parental interview about count of seizure frequency. Result: We administered TPM as monotherapy to twenty patients with newly diagnosed infantile spasms. This study included 17 boys and 3 girls, ranging in age from 3 to 24 months (mean age, 11 months). Regarding the etiology, cryptogenic group was 40%, and symptomatic 60%. Six (30%) patients became seizure free, eight (40%) patients achieved a seizure reduction of >50%, spasm frequency decreased from 10.6 ± 8.5 to 3.5 ± 1.4 spasms/day. Adverse effects during titration and stabilization included sleep disturbance, lethargy, irritability, rash, and oligohidrosis. Conclusion: TPM is effective and tolerated in patients with infantile spasm. Our results suggest that TPM may be considered a new first-line drug in infantile spasm.