Online link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478307/

Objectives

To evaluate the efficacy and tolerability of topiramate monotherapy in the treatment of JME.

Search methods

For the latest update, on 21 February 2017 we searched Cochrane Epilepsy’s Specialized Register, CENTRAL, MEDLINE, and ClinicalTrials.gov. We also searched ongoing trials registers, reference lists and relevant conference proceedings, and contacted study authors and pharmaceutical companies.

Main results

We included three studies with 83 participants. For efficacy, a greater proportion of participants in the topiramate group had a 50% or more reduction in primarily generalized tonic‐clonic seizures (PGTCS) compared with participants in the placebo group. There were no significant differences between topiramate versus valproate in participants responding with a 50% or more reduction in myoclonic seizures or in PGTCS or seizure‐free. Concerning tolerability, we ranked AEDs associated with topiramate as moderate‐to‐severe, while we ranked 59% of AEDs linked to valproate as severe complaints. Moreover, systemic toxicity scores were higher in the valproate group than the topiramate group.

Authors’ conclusions

Since the last version of this review we found no new studies. This review does not provide sufficient evidence to support topiramate for the treatment of people with JME. Based on the current limited available data, topiramate seems to be better tolerated than valproate, but there were no more benefits of efficacy in topiramate compared with valproate. In the future, well‐designed, double‐blind RCTs with large samples are required to test the efficacy and tolerability of topiramate in people with JME.

–          3 randomized controlled trials were included in this meta-analysis with a total population size of 83 patients.

–          Patients who were taking Topiramate had a 50% more reduction in generalized tonic‐clonic seizures than those patients in the placebo group.

–          There was no significant difference between those who took topiramate and those who took valproate as both treatments were able to reduce tonic-clonic seizure by 50%.

–          Participants in the topiramate group completed 24‐week maintenance therapy, in which 7/11 (64%) were seizure‐free. While participants in the valproate group completed 24‐week follow‐up, in which 9/16 (56%) were seizure‐free, showing topiramate could be a bit more effective in long term care.

–          When it came to alertness after a seizure episode, 43% of topiramate‐treated participants and 14% of valproate‐treated participants experienced marked/moderate improvement in alertness. Alertness worsened in one valproate‐treated participant.

–          When it came to adverse effects, people who received topiramate had moderate to severe adverse effects and those who received valproate, the majority of the adverse effects were reported as severe complaints.

–          In conclusion, topiramate is tolerated better than valproate as it has less adverse effects and less likely to lead to systemic toxicity.