A pilot study of topiramate in the treatment of infantile spasms

Epilepsia. 1998 Dec;39(12):1324-8. doi: 10.1111/j.1528-1157.1998.tb01331.x.


Purpose: West syndrome is a rare epileptic syndrome associated with infantile spasms, a specific abnormal electroencephalographic pattern (termed hypsarrhythmia), and mental retardation. Management of this disorder is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. Topiramate (TPM) is a new antiepileptic drug that may be effective in pediatric epilepsies. We conducted a pilot study to test the effects of rapid TPM dosing in patients with refractory infantile spasms.

Methods: Eleven children with refractory infantile spasms were given an initial dose of 25 mg TPM per day in addition to their current therapy. Dosage was increased by 25 mg every 2-3 days until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 24 mg/kg/day was achieved. Efficacy was primarily assessed by video EEG and secondarily by parental count of spasm frequency.

Results: Five (45%) subjects became spasm free during the study, with absence of infantile spasms and hypsarrhythmia (either classic or modified) proven by video EEG. Nine subjects, including the five spasm free, achieved a spasm reduction of > or =50%. Spasm frequency decreased from 25.6+/-19.3 to 6.9+/-5.9 spasms/day. Sixty-four percent of the subjects were able to achieve TPM monotherapy.

Conclusions: Results in this cohort of 11 patients with refractory disease show TPM to be a promising new agent for the treatment of infantile spasms.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / therapeutic use*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Electroencephalography
  • Female
  • Fructose / administration & dosage
  • Fructose / analogs & derivatives*
  • Fructose / therapeutic use
  • Humans
  • Infant
  • Male
  • Monitoring, Physiologic
  • Pilot Projects
  • Spasms, Infantile / drug therapy*
  • Topiramate
  • Treatment Outcome
  • Videotape Recording


  • Anticonvulsants
  • Topiramate
  • Fructose