Topiramate holds therapeutic potential in refractory, super-refractory status epilepticus

Use of topiramate (TPM) in the treatment of both refractory and super-refractory status epilepticus (SE) is safe and well tolerated and leads to SE resolution in a number of patients, according to a recent study.

Researchers reviewed the medical records of 854 SE patients treated in Frankfurt and Marburg between 2011 and 2016. Of the patients, 106 were treated with TPM; this group had a mean age of 67.4 years, with more than half being female (57.5 percent). Overall, SE patients had failed a median of five antiepileptic drugs.

The median latency from SE onset to TPM initiation was 8.5 days. TPM was administered at an initial dose of 100 mg/d, then uptitrated to a median maintenance dose of 400 mg/d. Treatment lasted a median of 12 days, and TPM was given as the last drug in 42 of 106 patients (39.6 percent).

Response to TPM was seen in 29 patients (27.4 percent), including 21 with refractory SE and eight with super-refractory SE.

The drug had a good safety profile. Treatment‐emergent adverse events occurred in two patients, one with pancreatitis and another with hyperchloremic acidosis. Meanwhile, hyperammonemia developed in 38 patients (35.8 percent), 34 of whom received a combination of TPM and valproate and/or phenobarbital. Intrahospital mortality rate was 22.6 percent (n=24).

Currently, TPM is not licensed for the treatment of SE, the researchers noted. “[So] the cases described here add to evidence from previous case series and animal studies that TPM might be a therapeutic option for refractory and super-refractory SE when other approved therapy protocols fail.”