Topiramate add‐on for drug‐resistant focal epilepsy | Figure 1

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Topiramate add‐on for drug‐resistant focal epilepsy

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Background

Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Most seizures can be controlled by a single antiepileptic drug. Unfortunately, some people require more than one antiepileptic medication to control their seizures, especially if these originate from one area of the brain (focal epilepsy), instead of affecting the entire brain (generalised epilepsy). These people are said to have drug‐resistant epilepsy. Topiramate can be used in addition to other antiepileptic drugs, called an add‐on treatment, to try to control drug‐resistant epilepsy.

Aim of this review

This review investigated the effectiveness and tolerability of topiramate when used as an add‐on treatment for people with drug‐resistant focal epilepsy.

Results

We found 12 trials that investigated topiramate as an add‐on treatment. They included a total of 1650 people with drug‐resistant focal epilepsy. These trials compared the antiepileptic drug topiramate to a placebo drug (an inactive, dummy drug which should not show any effect) for a period of up to 18 weeks. Taking all the evidence of the trials into account, the review found that topiramate is almost three times more effective, when used with other drugs, at reducing the number of seizures in drug‐resistant focal epilepsy than placebo. Adding topiramate to people's usual treatment was, however, associated with an increase in adverse effects such as problems with co‐ordination (ataxia), concentration, dizziness, drowsiness (somnolence), fatigue, 'thinking abnormally', tickling or numbness of the skin (paraesthesia) and weight loss. People taking add‐on topiramate were also more than twice as likely to withdraw from treatment than those taking placebo, most likely due to adverse effects.

Certainty of the evidence

We assessed the trials with regards to potential bias and certainty. Overall, we rated the certainty of the evidence as moderate to high which means that we are fairly certain that the findings that we have reported are accurate. The trials included in this review did not examine the long‐term effects of topiramate as an add‐on treatment and only one study investigated the use of add‐on topiramate in children. The findings should, therefore, only be applied to adults with drug‐resistant focal epilepsy. Future research should test which dose is most effective.

The evidence is current to July 2018.

Read the full Cochrane Review here

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\ \ Review question\ This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (2018, Issue 1) on 'Losigamone add‐on therapy for focal epilepsy'. We reviewed the evidence about the efficacy and tolerability of losigamone when used as an add‐on therapy for focal epilepsy. We found two studies.\ Background\ Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people have epilepsy that is not well controlled by a single antiepileptic drug (AED) and often require treatment with two or more AEDs (add‐on therapy). In recent years, many newer AEDs have been investigated as add‐on therapy for focal epilepsy; losigamone is one of these drugs. We wanted to know whether losigamone was an effective and tolerable treatment for people with focal epilepsy.\ Study characteristics\ The evidence is current to August 2019. We found two studies assessing add‐on losigamone for focal epilepsy, which recruited a total of 467 participants aged over 18 years. Both studies assessed losigamone 1200 mg/day or 1500 mg/day as an add‐on therapy for focal epilepsy.\ Key results\ The results of this review showed that participants taking losigamone as an add‐on treatment were more likely to reduce their seizure frequency by 50% or more in the short term; however losigamone was associated with more treatment withdrawal side effects than placebo. The most frequent adverse event caused by losigamone was dizziness.\ Quality of the evidence\ We assessed one study as being of good methodological quality while the other was of uncertain quality. We judged the overall quality of the evidence for the outcomes assessed as moderate.](https://app.figure1.com/case-detail/6331adea-d0f9-41a1-bd01-b467c0afb027)

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