Efficacy and Side Effects of Topiramate in Treatment of Children With Pseudotumor Cerebri Syndrome

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2024-07-08 DOI:10.1016/j.pediatrneurol.2024.06.015

Jacqueline Jeon-Chapman BS , Tais Estrela MD , Gena Heidary MD, PhD , Ryan Gise MD

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引用次数: 0

Abstract

Background

Topiramate is often considered as a second-line medication for the treatment of pseudotumor cerebri syndrome (PTCS), but limited studies exist that evaluate its efficacy in children.

Methods

Retrospective study of patients aged <21 years with PTCS who were treated with topiramate alone or in combination with acetazolamide was performed. Data regarding clinical courses and visual outcomes were recorded.

Results

A total of 46 patients were identified. Three (6.5%) patients were treated with topiramate alone, 31 (67.4%) transitioned to topiramate from acetazolamide, and 12 (26.1%) took both topiramate and acetazolamide concurrently. The median time to resolution of papilledema on topiramate was 0.57 years (interquartile range 0.32 to 0.84). Among eyes with papilledema graded on the Frisen scale at topiramate initiation, 40 of 57 (70.2%) were grade 1, nine of 57 (15.8%) were grade 2, and eight of 57 (14.0%) were grade 3. Twenty-seven of 46 (58.7%) reported headache improvement after starting topiramate. The mean dose of topiramate was 1.3 ± 0.8 mg/kg/day. The most common side effect was patient report of cognitive slowing (10 of 46 [21.7%]). All patients on topiramate monotherapy who were compliant with treatment and follow-up had resolution of papilledema with no evidence of visual function loss.

Conclusions

Topiramate can effectively treat PTCS in children with mild to moderate papilledema or in those unable to tolerate acetazolamide. More research is needed to assess the efficacy of topiramate for higher grade papilledema.

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托吡酯治疗儿童假性脑瘤综合征的疗效和副作用

背景托吡酯通常被认为是治疗假性脑瘤综合征（PTCS）的二线药物，但评估其在儿童中疗效的研究有限。结果共发现 46 例患者。3名患者（6.5%）单独接受了托吡酯治疗，31名患者（67.4%）从乙酰唑胺过渡到托吡酯，12名患者（26.1%）同时服用托吡酯和乙酰唑胺。服用托吡酯缓解乳头水肿的中位时间为 0.57 年（四分位距为 0.32 至 0.84）。在开始使用托吡酯时，根据弗里森量表对乳头水肿进行分级的眼睛中，57只眼睛中有40只（70.2%）为1级，57只眼睛中有9只（15.8%）为2级，57只眼睛中有8只（14.0%）为3级。46 例患者中有 27 例（58.7%）表示开始服用托吡酯后头痛有所改善。托吡酯的平均剂量为 1.3 ± 0.8 毫克/千克/天。最常见的副作用是患者报告认知能力减退（46 例中有 10 例 [21.7%]）。结论托吡酯可有效治疗轻度至中度乳头水肿儿童或不能耐受乙酰唑胺的儿童的 PTCS。需要进行更多的研究，以评估托吡酯对高度乳头水肿的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.