Cynthia Zheng1, Monica Hall1, Adam Kneepkens1, Sonya Wang2
1University of Minnesota, 2University of Minnesota Department of Pediatrics
Objective:
Topiramate is used for neonatal seizures; however, there is a paucity of data on the efficacy and safety of topiramate for neonatal seizures. In this study we describe the efficacy and safety of one institution’s experience with topiramate for neonatal seizures.
Background:
Currently there are no FDA approved drugs for neonatal seizures and a paucity of data to guide their management.1 Neonatal seizures are an important clinical problem associated with poor outcomes. Therapeutic management of neonatal seizures may improve long term outcome for patients. Topiramate is being used off-label for neonatal seizures; however, there is limited data in the literature on the efficacy and safety of topiramate in the neonatal population.2 Studies in animal models suggest topiramate is effective both as an antiepileptic and neuroprotective agent in newborns.3
Design/Methods:
A retrospective review was performed evaluating safety and seizure frequency response to topiramate. Only qualitative safety and seizure data from medical records, progress notes and EEG reports could be extracted and were categorized as decreased, unchanged or increased. Data from 7 patients who received topiramate for onset of seizures between the ages of 35-45 weeks gestation were collected and reviewed from January 2011 to December 2020. Topiramate doses ranged from 2 mg/kg/day to 18 mg/kg/day.
Results:
In the initial response, defined as 24hr after administration, there was decrease of clinical seizures confirmed with EEG in 71.4% of participants. At the 6 months follow up, 42.8% continued to have improvement. There were no reported adverse effects of topiramate.
Conclusions:
This case series suggests topiramate is effective for neonatal seizures especially for short-term control and may be as a treatment alternative to other more commonly used antiepileptics that have long-term consequences on brain development. Further investigation is warranted to explore the efficacy of topiramate for neonatal seizures.