Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
Abstract
BACKGROUND: Myoclonic-Astatic Epilepsy (MAE) usually starts before five
years of age and is associated with very frequent seizures and is
highly resistant to treatment. AIM: To investigate the outcome of
adjunctive topiramate (TPM) therapy in children with a diagnosis of MAE
syndrome. Subjects AND METHODS: In an outpatient setting, case notes of
27 children who received TPM were retrieved and analysed. RESULTS:
Records of 6 children with MAE, who were experiencing 2-8 atonic
seizures daily before starting TPM were studied. Improvement was noted
after addition of TPM (mean dose at steady-state 7.4±2.5mg/kg/day)
to the regimen of 1-3 anti-epileptic drugs they were receiving
concurrently. All but one child improved following the titration
period: one had 50-80% improvement in the frequency of atonic seizures
and three had over 80% improvement. However, one child who showed over
80% improvement and was free of atonic seizures, later developed
increased frequency of other seizure types. In one child there was no
significant improvement. Improvement has been sustained for over 6
months in three patients and over 4 months in one; three have continued
TPM. TPM was stopped in three patients (reduction in seizure control/no
improvement). CONCLUSIONS: This study supports the efficacy of TPM in
controlling atonic seizures in MAE and indicates that it should be
considered as an add-on drug in the management of this
'difficult-to-treat' epileptic syndrome