Topiramate in monotherapy and concomitant therapy for epilepsy

Objective To evaluate the efficacy and tolerability of topiramate(TPM) for epilepsy in add-on or monotheraphy and discuss optimal titration schedule. Methods 102 cases in group A received TPM as concomitant antiepileptic drugs(AEDs). Group B receiving TPM monotherapy and was divided into group B1 with 105 cases and group B2 with 95cases. The starting dose of TPM was 25mg/day and the dose was increased weekly by 25mg/day until 200mg/day was reached in group B1. The starting dose of TPM was 50mg /day and the dose was increased weekly by 50mg/day until 200mg/day was reached in group B2. Seizures and adverse events (AE) were recorded. Results 60.8% of patients in group A experienced a seizure reduction of or=75% and 24.5% were seizure-free while in group B were 76.8% and 41.5% respectively. There was significant difference between them( P(0.05)). There were 77.9% of group B1 and 75.8% of group B2 responded with or =50% decrease in seizure frequency. The seizure-free were 41.9% in group B1 and 40.0% in group B2.The difference of decrease of seizure between groupB1 and group B2 was not significant( P(0.05)). The efficacy of TPM to the three kinds of partial seizure and generalized tonic-clonic seizure was not of significant difference (P(0.05)). AE in group B2 was more remarkable than group B1 and the difference was significant. Conclusion TPM is effective to epilepsy not only as add-on as well as monotheraphy. A slower dose-titration with lower initial dose is preferable to patients with low seizure frequency while a faster-titration dose with higher initial dose is recommended to patients with high seizure frequency.