Abstracts

To report Gait Initiation Failure (GIF) occurring in four patients successfully treated with topiramate for refractory partial epilepsy. Retrospective medical charts analysis Four patients (three males) aged 21 to 65, with refractory partial epilepsy developed Gait Initiation Failure (GIF) when topiramate was added to their antiepileptic drug regimen. Three of them suffered from central epilepsy caused by ancient brain lesion responsible for hemiplegia (poststroke and posttraumatic epilepsy), whereas the last patient was treated since childhood for cryptogenic frontocentral epilepsy. Topiramate was used in all patients as add-on therapy, with dose ranging from 100 to 800mg/bid. All patients showed an excellent response to topiramate, as two became seizure-free and two exhibited a strong reduction in seizure frequency. Subsequently, GIF was reported as a selective difficulty in starting the walk after rest. Noteworthy, once the walk was initiate, no further difficulty was experienced. Other motor functions, except for ancient hemiparesis in three patients, including standing up before initiating walking, were normal. Fluorodopa PET and BetaCIT SPECT were performed in two patients, respectively. In one patient, a decrease in the BetaCIT uptake was shown controlaterally to the hemiparesis. A Transcranial Magnetic Stimulation study performed in one patient showed a selective loss of intracortical inhibition associated with GIF, both reversed by acute treatment with apomorphine. Except for one patient, who was successfully treated with apomorphine, GIF improved in all patients after reduction in topiramate dosage. However, in two patients, the decrease in topiramate dosage was associated with an increase in seizure frequency. An unpreviously reported motor side effect of topiramate is presented in four patients. Although the pharmacological action of topiramate remains almost obscure, a link can be speculated between the observed clinical efficacy on central seizures and Gait Initiation Failure reported by our patients.