Enteral topiramate treatment in refractory status epilepticus

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2025-04-02 DOI:10.1016/j.eplepsyres.2025.107551

Selda Keskin-Güler , Ömer Karadaş , Murat Mert Atmaca , Sibel Üstün Özek , Gulshan Yunisova , Eser Buluş , Fulya Eren , Melek Colak Atmaca , Aylin Reyhani , Candan Gürses

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引用次数: 0

Abstract

Objective

Refractory status epilepticus (RSE) is defined as persistent seizure activity despite first- and second-line antiepileptic medications (ASMs). Although benzodiazepines and a range of iv ASMs are available, mortality is 3–4 times higher than in those without RSE. Topiramate (TPM), a broad-spectrum ASM, may have neuroprotective, anti-inflammatory, and mitigating effects on neuronal injury. We aimed to investigate the efficacy of TPM and mortality in RSE.

Methods

This retrospective, multicentre study was conducted on RSE ≥ 18 years of age in six different universities and state hospitals in Ankara and Istanbul, Turkey. Demographic data, seizure classification and etiology were analyzed. TPM was loaded and a maintenance dose was scheduled. The outcomes, prognoses, comorbidities were analysed. The effectiveness of TPM and mortality rates of the patients were also analyzed.

Results

The study includes 60 patients with a mean age of 51.6 (±20, 20–84) years, 46.7 % were women. The patients were classified as having convulsive SE or nonconvulsive SE. TPM was performed as median third order ASM. The loading dose varied between 200 and 500 mg bid. The dose was subsequently reduced and maintained at 100–200 mg/day. There were 6 patients in whom TPM could not be continued due to adverse effects. TPM was considered successful in 22 patients, possibly successful in 23 patients and unsuccessful in 15 patients. Thirty-three patients were discharged from hospital, 8 were transferred to a rehabilitation center, 4 were transferred to a palliative care center and 13 died. There was no effect of age, gender, whether intubation was performed or not, etiologic classification, SE type (convulsive or nonconvulsive), duration of TPM administration, TPM loading dose on TPM success. Patients with RSE who were successfully treated with TPM had shorter hospital stays. The mortality predicting variables were determined as older age, not having epilepsy, failure to terminate RSE and acute symptomatic etiology.

Significance

This observational, multicenter study indicates that enteral TPM therapy is well tolerated, has a favorable safety profile, and is effective in patients with RSE. This is the first study in the literature to end SE with both high and low dose oral TPM treatment.

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.