Advertisement

CNS Drugs

, Volume 17, Issue 13, pp 985–992 | Cite as

Topiramate

As Monotherapy in Newly Diagnosed Epilepsy
Adis Drug Profile

Abstract

▴ Topiramate is an antiepileptic drug that has a broad spectrum of antiseizure effects, which appear to be the result of several neurostabilising pharmacological mechanisms. These include blockade of ion channels, potentiation of GABA neuroinhibition and glutamate receptor antagonism at non-NMDA receptors, as well as mild inhibition of carbonic anhydrase.

▴ Topiramate monotherapy dose dependently reduced the number of patients who met seizure related exit criteria in children (aged ≥6 years) and adults with epilepsy.

▴ This effect was also observed in patients who had previously experienced partial onset seizures and for those who had experienced generalised tonic clonic seizures. Six-month and 1-year seizure-free rates were dose-dependently reduced.

▴ In epilepsy, topiramate monotherapy 100 or 200 mg/day was as effective as carbamazepine 600 mg/ day or valproate 1250 mg/day as measured by time to study exit for any reason, time to first seizure and percentage of patients seizure-free in the final 6 months of treatment (mean treatment duration 244 days).

▴ Adverse events associated with topiramate monotherapy that were dosage related included paraesthesia, weight loss and diarrhoea. Renal calculi were also reported in both fully published trials.

Keywords

Carbamazepine Valproate Topiramate Zonisamide Clonic Seizure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Pledger G, Schmidt D. Evaluation of antiepileptic drug efficacy: a review of clinical trial design. Drugs 1994; 48(8): 498–590PubMedCrossRefGoogle Scholar
  2. 2.
    Mattson RH. Medical management of epilespy in adults. Neurology 1998 Nov; 51Suppl. 4: 15–20CrossRefGoogle Scholar
  3. 3.
    Mosby’s Drug Consult. Topiramate (3312) [online]. Available from URL: http://www.mosbysdrugconsult.com/ [Accessed 2003 Jun 19]
  4. 4.
    Ormrod D, McClellan K. Topiramate: a review of its use in childhood epilepsy. Paediatr Drugs 2001; 3(4): 293–319PubMedCrossRefGoogle Scholar
  5. 5.
    Gilliam FG, Veloso F, Bomhof MA, et al. A dose-comparison trial of topiramate as monotherapy in recently diagnosed partial epilepsy. Neurology 2003 Jan 28; 60(2): 196–202PubMedCrossRefGoogle Scholar
  6. 6.
    Langtry H, Gillis J, Davis R. Topiramate: a review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in the management of epilepsy. Drugs 1997 Nov; 54(5): 752–73PubMedCrossRefGoogle Scholar
  7. 7.
    Ortho-McNeil Pharmaceutical Inc. Topamax® (topiramate tablets): prescribing Information [online]. Available from URL: http://www.topamax.com/ [Accessed 2003 Jun 19]
  8. 8.
    Yang Y, Li Q, Shuaib A. Enhanced neuroprotection and reduced hemorragic incidence in focal cerebral ischemia of rat by low dose combination therapy of urokinase and topiramate. Neuro-pharmacology 2000 Mar; 39(5): 881–8Google Scholar
  9. 9.
    Lee S, Kim S, Kim J. Protective effect of topiramate against hippocampal neuronal damage after global ischemia in the gerbils. Neurosci Lett. 2000 Mar; 281(2): 183–6PubMedCrossRefGoogle Scholar
  10. 10.
    Amano K, Hamada K, Yagi K. Antiepileptic effects of topiramate on amygdaloid kindling in rats. Epilepsy Res 1998 Jul; 31(2): 123–8PubMedCrossRefGoogle Scholar
  11. 11.
    Sachdeo RC, Sachdeo SK, Levy RH, et al. Topiramate and phenytoin pharmacokinetics during repetitive monotherapy and combination therapy to epileptic patients. Epilepsia 2002 Jul; 43(7): 691–6PubMedCrossRefGoogle Scholar
  12. 12.
    Pellock J, Neto W, Wu SC, et al. Topiramate plasma concentrations during double-blind monotherapy studies [abstract no. 891172]. Epilepsia 2001; 42Suppl. 7: 212Google Scholar
  13. 13.
    Privitera MD, Brodie MJ, Mattson RH, et al. Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand 2003 Mar; 107(3): 165–75PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenfeld W, Doose D, Walker S, et al. Effect of topiramate on the pharmacokinetics of oral contraceptive containing norethindrone and ethinyl estradiol in patients with epilepsy. Epilepsia 1997; 38(3): 317–23PubMedCrossRefGoogle Scholar
  15. 15.
    Doose D, Wang S, Padmanabhan M, et al. Effect of topiramate or carbamazepine on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in healthy obese and nonobese female subjects. Epilepsia 2003; 44(4): 540–9PubMedCrossRefGoogle Scholar
  16. 16.
    Arroyo S, Squires L, Wang S, et al. Topiramate: effective as monotherapy in dose-response study in newly diagnosed epilepsy [abstract no. 926953]. Epilepsia 2002; 43Suppl. 7: 241Google Scholar
  17. 17.
    Kanner AM, Arroyo S, Squires L, et al. Response to topiramate monotherapy in newly diagnosed epilepsy: partial-onset vs. generalized seizures [abstract no. 939333]. Neurology 2003 Mar 11; 60Suppl. 1: 476–7Google Scholar
  18. 18.
    Ritter F, Gilliam F, Neto W, et al. 1-Year and 2-year seizure remission with topiramate monotherapy in newly/recently diagnosed localization-related epilepsy [abstract no. 891173]. Epilepsia 2001; 42Suppl. 7: 212–3Google Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  1. 1.Adis International LimitedMairangi Bay, AucklandNew Zealand

Personalised recommendations