Frequent infantile epilepsy therapy with Topiramate(TPM) by quick titration

Objective To Explore the efficiency of infantile epilepsy with topiramate (TPM) by quick titration. Methods Fourty three patients aged 2 months and 17 days to 2 years who suffered from many kinds infantile epilepsyi were observed. The dosage was started at the dosage of 1-2 mg/( kg·d), then titrated the dosage every 2-3 days or 3-7 days to the best response in 1,2 or 3 weeks. Results Titration peroid of 1-3 weeks were successfully finished in all patients. Final dosages were reached at the range of 2. 2 10 mg/(kg·d) [mean 4.9 ± 1.0 mg(kg·d) ]. The observed period of all patients were 3-9 months but only 4-8 weeks in 3 patients. Of them, maximal dosages were reached at the first week in 19 patients(44.2 % ), at the second week in 17 case (39.5 % ) and at the third week in 7 case( 16.3 % ) respectively. TPM were used as monotherapy in 26 patients with ±50 % seizure reduction of 83.3 % patients , and seizure free of 51.2 % patients. 51.2 % patients(22/43)appeared side effects, especially anorexia(9/22),lethargy(7/ 22)and weight losing(6/22). Among them, TPM were withdrew in two cases due to adiaphoresis with fever and tetters but combined use with Carbamazepin. All of the side effects disappeared during 2-7 weeks although continued TPM therapy. Conclusions Quick dosage titration of TPM would be efficient and safe for seizure controll in infants with frequent seizures. Anorexia and lethargy are early common side effect. The final dosage and different titrated steps must be carefully considered according to seizure frequency and individual tolerance. Close clinical observation and laboratory investigations could be more important because of their physiological characteristics in infantile period.