Topiramate in long-term treatment of epilepsy in the intellectually disabled.
Adding topiramate can halve seizures in many adults with ID who already take other drugs.
01Research in Context
What this study did
Doctors added topiramate to seizure drugs for adults with intellectual disability.
They tracked seizure counts for six months in a small case series.
What they found
Six out of every ten people had half as many seizures or better.
One in six stayed seizure-free for at least six months.
How this fits with other research
Branford (1996) also watched adults with ID, but cut antipsychotics instead of adding seizure pills.
Both studies show careful med changes can work, yet half may still need tweaks.
Kahng et al. (1999) used remote prompts to stop nail-biting; here, topiramate acts like a chemical prompt to calm brain firing.
Why it matters
If your client with ID still seizes on current meds, ask the neurologist about topiramate. Track seizure logs weekly so you can spot the same big drop these doctors saw.
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02At a glance
03Original abstract
BACKGROUND: To study the effectiveness of topiramate (TPM) in refractory epilepsy in patients who have intellectual disability (ID). METHODS: A representative population sample of 57 patients with ID (age range 2-61, mean 32.8) was administered add-on TPM for drug-refractory epilepsy. RESULTS: Seizure freedom for at least for 6 months was attained by 10 (17%), and seizure reduction of > or = 50% by further 26 (46%). Less than 50% decrease in seizure frequency was found in 16 (29%). TPM was more efficacious in localisation-related than in generalised epilepsies (81% vs. 50%, P=0.019). An at least 50% decrease in seizure frequency was achieved by patients with temporal lobe epilepsy in 100%, continuous spike-waves during sleep syndrome in 75%, Lennox-Gastaut syndrome in 52%, and those with infantile spasms in 25% of cases. As great decrease in seizure frequency was found in most patients with cortical dysplasia (83%), acquired encephalopathy with mesial temporal sclerosis (MTS) (75%), and genetic disease associated with MTS (66%). Adverse effects occurred in 10% including two (3%) with seizure aggravation and three (5%) necessitating discontinuation. CONCLUSION: TPM is an effective antiepileptic drug which is of value in treating people with seizures that are resistant to other antiepileptic medication. As a broad-spectrum drug it may substitute for polypharmacy and, at the same time decrease adverse effects and costs of therapy.
Journal of intellectual disability research : JIDR, 2005 · doi:10.1111/j.1365-2788.2005.00637.x