Stellenwert der niedrig dosierten Topiramat-Monotherapie von Epilepsien im Erwachsenenalter mit fokalen und generalisierten Anfällen

The current role of topiramate (TPM) in the treatment of epilepsy is described in this article. Data from randomized, double blind, controlled clinical trials are presented together with those from open label, non-interventional studies and interpreted in the context of the guidelines of the German Neurological Society (DGN). TPM is approved in Germany as a monotherapy for epilepsy in adults and children aged 2 and above since 2001. The guidelines of the DGN for the treatment of the first seizure list TPM as a therapy of choice for partial and idiopathic generalized epilepsy. The effectiveness and tolerability were to be considered high based on results of several randomised controlled studies for the treatment of partial epilepsy, generalised tonic-clonic seizures as well as various seizure types in the Lennox-Gastaut syndrome. The broad efficacy was regarded as especially advantageous due to the fact, that early in the treatment seizure type or epilepsy syndrome may be ambiguous. An initial target dose of 100 mg TPM is effective and well tolerated. Several studies including recent onset epilepsy in the elderly as well as elderly patients with epilepsy suggest that even lower doses, e. g. 50 - 75 mg/day can be sufficient to achieve seizure control with good tolerability. Tolerability had been an issue in early trials using high doses of TPM, however, with the use of lower doses, especially in monotherapy, the side effect profile has become favorable which was shown in controlled trials and is reflected in daily clinical routine as well.