(1)
Topiramate is helpful for some adults and children (aged over 4 years) with partial or generalised
epilepsy, when combined with an inadequate ongoing treatment. (2) The indications for
topiramate have now been extended in France to cover single-agent
therapy of
refractory epilepsy, from the age of 2 years. (3) A dose-finding study of 48 patients with refractory
partial epilepsy suggests that the efficacy of
topiramate monotherapy is dose-dependent. In a non comparative trial in 170 patients with refractory partial or generalised
epilepsy, 12 patients were able to switch to
topiramate alone after a phase of combining
topiramate with their ongoing treatment. (4) The licence extension to children over 2 years of age is based solely on the results of previous trials. (5) Two dose-finding studies, and a trial versus a standard
antiepileptic in which
topiramate was used alone, confirmed that the safety profile of
topiramate is similar to that of other
antiepileptics, neuropsychological disturbance predominating. (6) Other adverse effects more specific to
topiramate include cognitive and language problems,
weight loss and reduced appetite, acute
myopias sometimes associated with intraocular
hypertension, an increased risk of renal
lithiasis, reduced sweating with a risk of
hyperthermia, and
metabolic acidosis. (7) In practice, some patients whose
epilepsy is refractory to an optimally administered treatment may improve when
topiramate is added; and a small minority of them can gradually discontinue their previous treatment.