Özlem ÖZDEMİR, Mehmet OKAN, Aysun N. BEYAZIT

İnatçı epilepsili çocuklarda ek tedavi olarak topiramat etkinliğinin ve yan etkilerinin değerlendirilmesi

Giriş: Bu çalışmada çocukluk çağında dirençli epileptik vakalarda ek ilaç olarak topiramat tedavisinin etkinliğinin ve yan etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya alınan 166 hasta (67 kız, 99 erkek) topiramat etkinliği ve yan etkiler açısından retrospektif olarak incelendi. Hastaların 82’si (%49,4) parsiyel, 8’i (%4,8) generalize, 6’sı (%3,8) sekonder generalize, 24’ü (%14,5) myoklonik epilepsi tanısı alırken, 34 hasta (%27,7) epileptik sendrom sınıfında yer aldı. Topiramat dozu 0,5 mg/kg/g dozunda başlanarak ortalama 9 mg/kg/g’e çıkıldı. Hastalar her kontrol sırasında nöbet sıklığı, süresi ve yan etkiler açısından değerlendirildi. İlacın etkinliği iyi (tam, >%75), kısmi (%25-75) ve kötü (%0-25) şeklinde sınıflandırıldı.Bulgular: Çalışmaya alınan 166 hastanın 85’inde (%51,2) iyi, 39’unda (%23,5) kısmi ve 42’sinde (%25,5) kötü yanıt elde edildi. Topiramat tedavisi ile parsiyel epilepsili hastaların 45’inde (%54,9) iyi, 22’sinde (%26,8) kısmi, 15’inde (%18,3) kötü yanıt, generalize epilepsili hastaların ise tümünde (n=8) iyi yanıt alınırken myoklonik epilepsili hastaların 10’unda (%41,7) iyi, 4’ünde (%16,7) kısmi ve 10’unda (%41,7) kötü yanıt elde edildi. Genel olarak topiramat tedavisi parsiyel epilepsili hastalarda generalize ve myoklonik epilepsiye göre daha etkin bulundu (p=0,008, p=0,024). Topiramata bağlı yan etki 33 hastada (%19,9) saptandı. En sık görülen yan etki somnolans (n=9, %5,4) idi. Topiramat tedavisi 33 hastada (%19,9) yanıt alınamaması, 4 hastada (%2,4) ciddi yan etkinin görülmesi, 3 hastada (%1,8) nöbet artışı ve 2 hastada da (%1,2) uzun süreli nöbetsiz izlem nedeniyle sonlandırıldı.Sonuç: Topiramatın inatçı epileptik vakalarda ek tedavi olarak etkinliğinin yüksek, ciddi yan etkilerinin olmaması nedeniyle güvenilir olduğu görülmüştür. İnatçı epilepsilerde ek tedavi olarak tercih edilebileceği, ancak ilacın kendine özgü yan etkileri açısından yakın takip edilmesi gerektiği düşünüldü.

The efficacy and adverse effects of topiramate in add on therapy in children with intractable epilepsy

Introduction: The aim of this study was to evaluate the efficacy and adverse effects of topiramate add on therapy in children with intractable epilepsy. Materials and Method: The efficacy and adverse events of topiramate were evaluated in 166 children (67 girls, 99 boys). The classification of the epilepsies were as follows: partial 82 (49.4%), generalized 8 (4.8%), secondarily generalized 6 (3.8%), myoclonic 24 (14.5%) and epileptic syndromes 34 (27.7%). Topiramate was initiated at a daily dose of 0.5-1 mg/kg, up to an approximate daily dose of 9 mg/kg. The patients were assessed for the seizure frequency, duration and adverse events during the follow-up. Response to treatment was classified as good (complete, >75%), moderately (25-75%) and poor (0-25%).Results: Response to treatment among 166 patients were as follows: 85 (51.2%) good, 39 (23.5%) moderately and 42 (25.3%) poor. The efficacy rates according to the seizure types were 45 (54.9%) good, 22 (26.8%) moderately, 15 (18.3%) poor for partial seizures; 8 (100%) good for generalized whereas 10 (41.7%) good, 4 (16.7%) moderately and 10 (41.7%) poor for myoclonic seizures. Generally topiramate appeared to be more effective in partial epilepsy than generalized and myoclonic epilepsy (p=0.008 and p=0.024). Adverse events were present in 33 patients (19.9%), mostly as somnolence (n=9, 5.4%). Topiramate was discontinued because of poor response in 33 patients (19.9%), severe adverse events in 4 (2.4%), increase in the frequency of seizures in 3 (1.8%) and long term seizure free follow-up in 2 (1.2%). Conclusion: Topiramate seems to be highly effective and safe in intractable epileptic patients. However, the drug specific adverse events should always be kept in mind during the follow-up.

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