Exploring efficacy and tolerability outcomes in patients with difficult‐to‐treat epilepsy receiving adjunctive topiramate at different titration rates – an exploratory study

Objective – To compare rapid vs regular titration of topiramate concerning efficacy and safety. Materials and methods – Open‐label, prospective, single‐center study exploring efficacy and tolerability of two adjunctive dosing regimens of topiramate (TPM) in adult patients with difficult‐to‐treat epilepsy. Based on investigator judgment, 21 of 50 consecutive patients received a rapid titration (starting dose 50 mg/day, stepwise increase with 50 mg/day after 3 days each until reaching the target dose), while the other 29 patients received titration according to the German prescribing information (starting dose 25 mg/day, stepwise increase with 25–50 mg/day every 7 days). Patients were observed until the target dose was reached and 3 months thereafter. Results – Mean final dosages were 136 mg/day (regular titration) and 213 mg/day (rapid titration). Efficacy and tolerability measures did not differ significantly. Forty‐six percent of all patients experienced a seizure reduction of ≥50%; 14% became seizure free. No serious adverse events occurred. The most common adverse effects were tiredness (20%), memory and language difficulties (18% each), slowness in thinking and speech (10%), psychomotor disturbance (8%) and paresthesia (8%). Conclusions – This study suggests that rapid and conventional titration generate similar tolerability, safety and effectiveness in selected patients.