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. 2017 Apr 23;4(4):CD010008.
doi: 10.1002/14651858.CD010008.pub3.

Topiramate monotherapy for juvenile myoclonic epilepsy

Jia Liu  1 , Lu-Ning Wang  2 , Yu-Ping Wang  1
Affiliations

Topiramate monotherapy for juvenile myoclonic epilepsy

Jia Liu et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Topiramate is a newer broad-spectrum antiepileptic drug (AED). Some studies have shown the benefits of topiramate monotherapy in the treatment of juvenile myoclonic epilepsy (JME). However, there are no current systematic reviews to determine the efficacy and tolerability of topiramate monotherapy in people with JME. This is an updated version of the original Cochrane Review published in Issue 12, 2015.

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.

Selection criteria: We included randomized controlled trials (RCTs) investigating topiramate monotherapy versus placebo or other AED treatment for people with JME, with the outcomes of proportion of responders or experiencing adverse events (AEs).

Data collection and analysis: Two review authors independently screened the titles and abstracts of identified records, selected studies for inclusion, extracted data, cross-checked the data for accuracy and assessed the methodological quality. We performed no meta-analyses due to the limited available data.

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. We judged the quality of the evidence from the studies to be very low.

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.

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Conflict of interest statement

Jia Liu; none known Lu‐Ning Wang: none known Yu‐Ping Wang: none known

Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figure 3
Figure 3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Analysis 1.1
Analysis 1.1
Comparison 1 Topiramate versus placebo, Outcome 1 Proportion of responders (at least 50% seizure frequency reduction in PGTCS).
Analysis 1.2
Analysis 1.2
Comparison 1 Topiramate versus placebo, Outcome 2 Nausea.
Analysis 1.3
Analysis 1.3
Comparison 1 Topiramate versus placebo, Outcome 3 Upper respiratory tract infection.
Analysis 1.4
Analysis 1.4
Comparison 1 Topiramate versus placebo, Outcome 4 Abnormal vision.
Analysis 1.5
Analysis 1.5
Comparison 1 Topiramate versus placebo, Outcome 5 Diarrhea.
Analysis 2.1
Analysis 2.1
Comparison 2 Topiramate versus valproate, Outcome 1 Proportion of responders (at least 50% seizure frequency reduction in myoclonic seizures).
Analysis 2.2
Analysis 2.2
Comparison 2 Topiramate versus valproate, Outcome 2 Proportion of responders (at least 50% seizure frequency reduction in PGTCS).
Analysis 2.3
Analysis 2.3
Comparison 2 Topiramate versus valproate, Outcome 3 Number of participants with seizure‐free.
Analysis 2.4
Analysis 2.4
Comparison 2 Topiramate versus valproate, Outcome 4 Paresthesia.
Analysis 2.5
Analysis 2.5
Comparison 2 Topiramate versus valproate, Outcome 5 Weight gain.
Analysis 2.6
Analysis 2.6
Comparison 2 Topiramate versus valproate, Outcome 6 Tremor.
Analysis 2.7
Analysis 2.7
Comparison 2 Topiramate versus valproate, Outcome 7 Headache.
Analysis 2.8
Analysis 2.8
Comparison 2 Topiramate versus valproate, Outcome 8 Concentration difficulty.
Analysis 2.9
Analysis 2.9
Comparison 2 Topiramate versus valproate, Outcome 9 Fatigue.
Analysis 2.10
Analysis 2.10
Comparison 2 Topiramate versus valproate, Outcome 10 Alopecia.
Analysis 2.11
Analysis 2.11
Comparison 2 Topiramate versus valproate, Outcome 11 Dizziness.
Analysis 2.12
Analysis 2.12
Comparison 2 Topiramate versus valproate, Outcome 12 Weight loss.
Analysis 2.13
Analysis 2.13
Comparison 2 Topiramate versus valproate, Outcome 13 Psychomotor slowing.
Analysis 2.14
Analysis 2.14
Comparison 2 Topiramate versus valproate, Outcome 14 Somnolence.
Analysis 2.15
Analysis 2.15
Comparison 2 Topiramate versus valproate, Outcome 15 Nausea.
Analysis 2.16
Analysis 2.16
Comparison 2 Topiramate versus valproate, Outcome 16 Appetite increase.
Analysis 2.17
Analysis 2.17
Comparison 2 Topiramate versus valproate, Outcome 17 Insomnia.
Analysis 2.18
Analysis 2.18
Comparison 2 Topiramate versus valproate, Outcome 18 Abnormal vision.
Analysis 2.19
Analysis 2.19
Comparison 2 Topiramate versus valproate, Outcome 19 Rash.
Analysis 2.20
Analysis 2.20
Comparison 2 Topiramate versus valproate, Outcome 20 Anorexia.
Analysis 2.21
Analysis 2.21
Comparison 2 Topiramate versus valproate, Outcome 21 Hallucination.
Analysis 2.22
Analysis 2.22
Comparison 2 Topiramate versus valproate, Outcome 22 Diarrhea.
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References

References to studies included in this review

    1. Biton V, Bourgeois BF, YTC/YTCE Study Investigators. Topiramate in patients with juvenile myoclonic epilepsy. Archives of Neurology 2005;62:1705‐8. - PubMed
    1. Levisohn PM, Holland KD. Topiramate or valproate in patients with juvenile myoclonic epilepsy: a randomized open‐label comparison. Epilepsy & Behavior 2007;10:547‐52. - PubMed
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    1. Biton V, Montouris GD, Ritter F, Riviello JJ, Reife R, Lim P, et al. A randomized, placebo‐controlled study of topiramate in primary generalized tonic‐clonic seizures. Neurology 1999;52:1330‐7. - PubMed
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References to other published versions of this review

    1. Liu J, Wang LN. Topiramate monotherapy for juvenile myoclonic epilepsy. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD010008] - DOI
    1. Liu J, Wang LN, Wang YP. Topiramate monotherapy for juvenile myoclonic epilepsy. Cochrane Database of Systematic Reviews 2015, Issue 12. [DOI: 10.1002/14651858.CD010008.pub2] - DOI - PubMed

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