Effectiveness of Topiramate in Medically Complicated Patients with Status Epilepticus or Acute Refractory Seizures

BACKGROUND AND PURPOSE The conventional therapeutic regimen for status epilepticus (SE) may require artificial ventilation and hemodynamic support, and is associated with significant complications and increased mortality. We investigated the safety and effectiveness of topiramate (TPM) in patients with refractory SE, who had medical complications such as systemic infection, renal dysfunction, hepatic dysfunction, and bone marrow suppression. METHODS We analyzed the clinical features and therapeutic outcome in 16 patients with GCSE, NCSE or recurrent GTC in whom TPM was administered for its control. RESULTS The majority of our patients had GCSE (n=6) or NCSE (n=7). The common co-morbid diseases at the onset of seizures were hematological disorders (pancytopenia 8, anemia 2, anemia with thrombocytopenia 2) and sepsis (n=8). Twelve patients were under the renal and/or hepatic dysfunction. Within a few days, 13 patients could experience their seizure control (the mean duration, 3.7± 2.6 days), but the seizures of the other subjects did not be terminated in spite of all efforts. No patients experienced a worsening of their CBC or blood chemistry profiles with the TPM treatment. CONCLUSIONS We could confirm that TPM was not only safe but very effective for the control of recurrent epileptic seizures or SE in patients with serious medical co-morbidities. TPM may be considered as another treatment option when conventional protocols are ineffective.