Long-term Follow-up Study Of Topiramate Monotherapy For Symptomatic Epilepsy In Infants

Purpose:To observe the clinical therapeutic effect,tolerance,safety,retention and the reason for discontinuation of topiramate(TPM,brand name: Topamax)in treating symptomatic epilepsy in infants.Methods:We collected data of 50 patients with symptomatic epilepsy through out-patient clinic or in-patient department of neurology of Children's Hospital Affiliated to Soochow University.A long-term follow-up for all 50 patients(26 males and 24 females)who taken topiramate since April in 2012.Data records include gender,age,etiological agent,the results of CT/MRI,duration,dosage,the type and frequency of epilepsy before and after medication,and the presence of adverse drug reactions,et al.To evaluate the effect rate,retention rate and adverse effects after using the medication at 1 year,2 years,3 years,4 years.Kaplan-Meier and Cox proportional hazards regression model were used to calculate the retention rate and analyze the risk factors for retention rate.Results:From the beginning of using the medicine,the effect rate was 66.00% at 1 year,61.90% at 2 years,58.33% at 3 years,and 53.33% at 4 years;the rate of complete remission was 44.00%,42.86%,41.67%,36.67% respectively at 1 year,2 years,3 years,4 years.There was no difference in total effect rate and complete remission rate between focal seizure and general seizure by topiramate monotherapy.For different causes of symptomatic epilepsy,a better effect of topiramate monotherapy could be observed in intracranial infection sequelae,hypoxic ischemia encephalopathy,traumatic cerebral infarction and periventricular lucency.However,there was a low total effect rate and complete remission rate about the etiopathogenisis of gray matter heterotopia,tuberous sclerosis,encephalofacial angiomatosis and cerebral white matter dysplasia.The main adverse effects of topiramate includes drowsiness,hypodynamia,weight loss,anepithymia,vomit,diarrhea,hypohidrosis,slowly thinking active,attention disorders,et al.The retention rate was 84.00% at 1 year,72.00% at 2 years,60.00% at 3 years,and 48.00% at 4 years.The main causes of stopping medication were lower curative effect of topiramate monotherapy and side effects.Conclusions:There is a better effect and safety of topiramate in treating symptomatic epilepsy in infants.There is a higher retention of topiramate in a long-term follow-up.Major factors that affect the retention are lower curative effect and adverse reactions to drug.For refractory symptomatic epilepsy in infant,the combination of drug therapy,surgical treatment,ketogenic diet,and vagus nerve stimulation can improve curative effect.Slowly add quantity and low dose treatment can reduce adverse drug reactions,improve compliance and a higher retention rate.