Topiramate as an Adjunctive Treatment for Refractory Infantile Spasms

Abstract

Background & Aim: Management of infantile spasms is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective in completely controlling of seizures. We conducted this study to determine the efficacy, safety and tolerance of Topiramate (TPM) as add-on therapy in children with intractable infantile spasms.

Subjects &Methods: A prospective clinical trial included 29 children with refractory infantile spasms, who were admitted to the neurological clinic at University Children's Hospital in Damascus between 1/12/2017-1/5/2020, and given Topiramate at a starting dose of 1-2 mg/kg/day in two doses. Daily dosage was increased by 1-2 mg/kg/day every 1-2 week until the spasms disappeared or to a maximum daily dosage of 10 mg/kg/day, during that we monitored the response.

Results: There were 18 males (62%) and 11 females (38%) registered in this study, and the age at onset of spasms was from 3 to 12 months (median 7.5). As to the etiology of infantile spasms, there were a cryptogenic group (n=7) (24%) and a symptomatic group (n=22) (76%). Overall, spasms in 4 patients (14%) were completely controlled. A ≥50% reduction in spasms was observed in 13 patients (45%), A ≤50% reduction in spasms was observed in 7 (24%), we found no difference in 4 patients (14%), while one patient (3%) quit the treatment because adverse effects. The mean dose of TPM during stabilization was 6.5 mg/kg/d.

Adverse events were mild to moderate and observed in 6 patients (20%). The most frequent  symptom was body weight loss, which occurred in 17%.

Conclusions: We conclude that TPM as adjunctive therapy is a promising drug in children with intractable infantile spasms.