Topiramate or valproate in patients with juvenile myoclonic epilepsy: a randomized open-label comparison

Epilepsy Behav. 2007 Jun;10(4):547-52. doi: 10.1016/j.yebeh.2007.03.003. Epub 2007 May 4.


Few randomized, controlled trials evaluating antiepileptic drug (AED) efficacy and tolerability have focused solely on patients with juvenile myoclonic epilepsy (JME). We conducted a pilot, randomized controlled trial comparing topiramate (N=19) and valproate (N=9) in adolescents/adults with JME to evaluate clinical response when these broad-spectrum agents are titrated to optimal effect. Rating scales were used to systematically assess tolerability. Among patients completing 26 weeks of treatment, 8 of 12 (67%) in the topiramate group and 4 of 7 (57%) in the valproate group were seizure-free during the 12-week maintenance period. Median daily dose was 250mg topiramate or 750mg valproate. Two (11%) topiramate-treated patients and one (11%) valproate-treated patient discontinued due to adverse events. Systemic toxicity scores, but not neurotoxicity scores, differed substantially between the two groups; greater systemic toxicity was associated with valproate. Our preliminary findings that topiramate may be an effective, well-tolerated alternative to valproate warrant validation in a double-blind trial.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use*
  • Child
  • Double-Blind Method
  • Female
  • Fructose / adverse effects
  • Fructose / analogs & derivatives*
  • Fructose / therapeutic use
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myoclonic Epilepsy, Juvenile / drug therapy*
  • Neurotoxicity Syndromes / epidemiology
  • Pilot Projects
  • Seizures / epidemiology
  • Seizures / prevention & control
  • Tomography, X-Ray Computed
  • Topiramate
  • Valproic Acid / adverse effects
  • Valproic Acid / therapeutic use*


  • Anticonvulsants
  • Topiramate
  • Fructose
  • Valproic Acid