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Seizure Drug May Be Effective When Others Fail

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WebMD Health News

Sept. 12, 2000 -- With advances in seizure medication over the last few years, more and more victims of epilepsy are able to live life to the fullest despite their illness. But there are still many patients whose seizures remain uncontrolled, even after a great deal of trial and error with various drug combinations.

Now, new research published in the August issue of the journal Epilepsia, indicates that when seizures are difficult to control with other conventional medications, the drug Topamax may come to the rescue.

Most people are unaware that there are several types of seizures. In some seizures, the entire body moves abnormally. In others, only a part of the body may be affected and some seizures may not be noticeable at all. Different seizures also involve different parts of the brain. Study co-author Linda J. Stephen, MD, tells WebMD that Topamax is effective at controlling the various types even at very small doses. She is deputy director of the Epilepsy Unit at Western Infirmary in Glasgow, Scotland.

Another expert agrees. "Topamax is indeed very powerful for a wide range of epilepsies," Victor Biton, MD, tells WebMD. Biton is director of the Seizure Unit at Baptist Hospital and president of the Arkansas Epilepsy Program in Little Rock.

At the Western Infirmary, 170 patients with seizures difficult to control on other medications were given Topamax in addition to their usual treatment.

More than 20% of patients became seizure-free for at least six months on Topamax, and almost 50% more had a reduction in their monthly seizures by at least half.

Unfortunately, the remaining 30% of patients had to stop Topamax because of side effects including worsening seizures, fatigue, weight loss, irritability, tingling sensations, depression, and headache. Three patients developed kidney stones but continued taking Topamax because of improvement in their seizures.

"Most side effects occur in the first two to eight weeks," William E. Rosenfeld, MD, tells WebMD. He is director of The Comprehensive Epilepsy Care Center for Children and Adults at St. Luke's Hospital in St. Louis and was not involved in the study. "By going slow and easy with [increasing the dose], you can eliminate most side effects."

Patients in the Glasgow study had a good result even from doses of Topamax that were lower than in earlier studies. A few patients had good seizure control even when all drugs were stopped except Topamax. This was surprising, because Topamax is usually used only in addition to other drugs. In Rosenfeld's experience, up to one-third of patients can achieve good seizure control using Topamax alone.

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