Topiramate in intractable childhood onset epilepsy--a cautionary note

Can J Neurol Sci. 1999 Nov;26(4):271-3. doi: 10.1017/s0317167100000366.


Objectives: To study the effectiveness and safety of topiramate in clinical practice, for a group of patients with childhood onset epilepsy.

Methods: All patients treated with topiramate at the three study centers between November 1995 and December 31, 1997 were analyzed retrospectively, using a standardized study protocol. Data were gathered on demographic features, seizures response and medication related adverse events.

Results: Eighty-seven patients were treated with topiramate. Over 90% seizure reduction was achieved in 8 (9%) patients, 50%-90% in 21 (24%), < 50% in 54 (62%) patients. Four patients (5%) had a deterioration in seizure control. Adverse events required topiramate discontinuation in 36 (41%). Of these 27 (31%) complained of unacceptable cognitive dulling. The rate of dose escalation and final dose in mg/kg were similar in those who remained on topiramate and those who were intolerant because of cognitive side effects.

Conclusions: Although topiramate resulted in > 50% seizure reduction in 29 (33%) of this group of patients with difficult epilepsy, its usefulness was limited by a high incidence of adverse effects. Adverse events prevented ongoing therapy for 36 (41%) and cognitive dulling resulted in topiramate discontinuation by 27 (31%) of the group.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Age of Onset
  • Anticonvulsants / adverse effects*
  • Child
  • Child, Preschool
  • Epilepsies, Myoclonic / drug therapy
  • Epilepsy / drug therapy*
  • Epilepsy, Absence / drug therapy
  • Epilepsy, Complex Partial / drug therapy
  • Epilepsy, Generalized / drug therapy
  • Fructose / adverse effects
  • Fructose / analogs & derivatives*
  • Humans
  • Infant
  • Retrospective Studies
  • Topiramate


  • Anticonvulsants
  • Topiramate
  • Fructose