topiramate and Child-Behavior-Disorders

To evaluate the cognitive and behavioral effects of topiramate (TPM) versus carbamazepine (CBZ) using efficacious doses of each drug as monotherapy for children with benign rolandic epilepsy.. A multicenter, randomized, open-label, observer-blinded, parallel-group clinical trial was conducted. TPM was introduced at a dose of 12.5 mg/day with the minimum target dose of 50 mg/day in patients <30 kg and 75 mg/day in patients >30 kg over 4 weeks. CBZ was started at a dose of 10 mg/kg/day with the minimum target dose of 20 mg/kg/day over 4 weeks. Additional individual escalation was allowed up to a maximum target dose. The primary study end point was change on a neuropsychological test battery after 28 weeks of treatment.. Neuropsychological data were available for 88 patients (45 patients for TPM and 43 patients for CBZ). Of the cognitive variables measured, arithmetic showed significant worsening in TPM (p = 0.037). An additional test, for maze, also showed a significantly greater improvement for CBZ (p = 0.026). Of behavioral variables, no significant changes were found but the scores had a negative trend for the TPM. When 30 patients on the minimum target dose for TPM were compared to 40 patients treated with minimum target CBZ, there was no significant worsening of cognitive and behavioral effects in the TPM.. The pattern of neuropsychometric changes with TPM seemed to be slightly worse overall than CBZ. However, outcome with the minimum target dose did not differ significantly in comparisons between the treatment groups.

Topics: Adolescent; Age Factors; Anticonvulsants; Carbamazepine; Child; Child Behavior Disorders; Child, Preschool; Cognition Disorders; Dose-Response Relationship, Drug; Drug Administration Schedule; Epilepsy, Rolandic; Fructose; Humans; Neuropsychological Tests; Personality Inventory; Topiramate; Treatment Outcome

To evaluate the efficacy and tolerability of topiramate (TPM) as add-on therapy in children less than 12 years of age with refractory epilepsy, according to epilepsy syndromes, we conducted an open, prospective, pragmatic and multicenter study in France. Efficacy was assessed, especially according to epilepsy syndromes, as well as tolerability. We included 207 children (41 of whom were less than 4 years of age). TPM was effective (responders with >50% decrease in seizure frequency) in 50% of 128 patients with partial epilepsy, and in 44% of 79 patients with generalized epilepsy. In case of generalized epilepsy, responders more frequently had generalized symptomatic epilepsy, severe myoclonic epilepsy and myoclono-astatic epilepsy, whereas response rate was mild in both infantile spasms and Lennox-Gastaut syndrome (LGS). Improvement was well maintained in all patients during the treatment period (median 5.6 months). Seizure frequency/severity increased (worsening) in 13% of patients with partial epilepsy and 17% with generalized epilepsy (particularly in those with infantile spasms), and resulted in withdrawal of TPM for 8%. The most frequently reported adverse events were moderate neurobehavioral and gastrointestinal disorders. Adverse events led to withdrawal of TPM from 13.5% of patients. Children less than 4 years of age had particularly good tolerability. Results confirm that TPM is effective and well tolerated in children under 12 years of age in a broad range of epilepsy syndromes, including refractory partial epilepsy, and symptomatic and myoclonic generalized epilepsy. Use of TPM should be considered in children under 4 years of age, and slow and progressive titration is important.

Topics: Anticonvulsants; Child; Child Behavior Disorders; Child, Preschool; Epilepsy; Female; Fructose; Gastrointestinal Diseases; Humans; Infant; Male; Nervous System Diseases; Prospective Studies; Syndrome; Topiramate; Treatment Outcome

It has been reported that vagus nerve stimulation (VNS) improves behavior in children, whereas topiramate has a less clear effect. Three boys, aged 5-12 years, with generalized slow spike-wave discharges and refractory epilepsy, were treated with combination therapy of topiramate and VNS. All three had a significant reduction in seizures, but even more dramatic improvement in aggression, social interaction, and ambulation. The Cyberonics Patient Outcome Registry was subsequently queried and a beneficial effect of this combination therapy on behavior (specifically alertness) beyond that of VNS and other anticonvulsants was noted. This did not appear to be due solely to seizure reduction, which was observed only differentially at 12 months.

Topics: Anticonvulsants; Arousal; Child; Child Behavior Disorders; Child, Preschool; Combined Modality Therapy; Educational Status; Electric Stimulation Therapy; Electroencephalography; Epilepsy; Evoked Potentials; Fructose; Humans; Male; Memory; Quality of Life; Registries; Social Behavior; Topiramate; Treatment Outcome; Vagus Nerve; Verbal Behavior

Topics: Anticonvulsants; Attention Deficit Disorder with Hyperactivity; Bipolar Disorder; Child; Child Behavior Disorders; Cognition Disorders; Fructose; Humans; Male; Topiramate

The objective of this study was to examine the factors associated with the occurrence of behavioral and cognitive abnormalities in children treated with topiramate. A retrospective chart review of patients up to 18 years of age who had been treated with topiramate at a tertiary epilepsy center was performed. Behavioral or cognitive abnormalities were observed in 11 (14.6%) of 75 children between 2 weeks and 4 months after initiation of therapy. The mean dosage (4.6 mg/kg daily) at which these abnormalities were observed was similar to the mean final dose (5.8 mg/kg daily) in children without abnormalities. The mean rate of dosage increase was 0.72 mg/kg weekly and 0.7 mg/kg weekly in those with and without abnormalities, respectively. Five of the 11 children with behavioral or cognitive abnormalities had a previous history of behavioral or cognitive abnormalities, but only nine of the 64 children without abnormalities had a previous history of behavioral or cognitive abnormalities (P = 0.03). Lamotrigine was used concurrently in four of the 11 children with behavioral or cognitive abnormalities but in only seven of the 64 children without abnormalities (P = 0.05). Behavioral and cognitive abnormalities in children treated with topiramate do not appear to be related to the rate of dosage increase. A previous history of behavioral problems and the concurrent use of lamotrigine may be predisposing factors.

Topics: Adolescent; Anticonvulsants; Child; Child Behavior Disorders; Child, Preschool; Cognition Disorders; Dose-Response Relationship, Drug; Drug Therapy, Combination; Epilepsy; Female; Fructose; Humans; Infant; Lamotrigine; Male; Medical Records; Retrospective Studies; Risk Factors; Topiramate; Treatment Outcome; Triazines

A 3-year retrospective review was undertaken of the use of topiramate in 51 children aged 3-16 years with partial and generalized epilepsies who attended a tertiary referral epilepsy centre in a large children's hospital. The mean follow-up period was 19 months (range 6-33 months). Twenty-six children (51%) were still receiving topiramate at the time of their last review. Fifteen children (29%) showed a greater than 50% reduction in their seizure frequency and four children (8%) became seizure free, three on topiramate monotherapy. The drug appeared to be most effective in children with moderate learning difficulties with 75% showing an improvement in seizure control compared with 25% of children with normal educational functioning. Topiramate was withdrawn in 25 patients. The reasons for withdrawal included adverse effects in 20, lack of effect in three and worsening of seizures in two patients. Adverse side effects were reported in 57% of the 51 patients. The majority of the side effects were related to behavioural and cognitive difficulties, with less-common side effects including anorexia, weight loss and headaches.

Topics: Adolescent; Anticonvulsants; Child; Child Behavior Disorders; Child, Preschool; Cognition Disorders; Drug Tolerance; Epilepsy; Female; Follow-Up Studies; Fructose; Humans; Male; Medical Audit; Retrospective Studies; Topiramate; Treatment Outcome