Abstracts

Assess weight changes and tolerability in elderly epilepsy patients taking Topiramate.
Topiramate is an effective anticonvulsant with a broad-spectrum of action across seizure types. Weight loss has often been reported as a side effect during treatment with Topiramate. However, in 2000, NIH publicly reported that 60% of Americans are overweight or obese with body mass index over 25 and 30, respectively. Thus, weight loss in epilepsy patients may reflect weight normalization, and actually improve other concomitant medical problems such as diabetes. Although weight loss associated with Topiramate has been studied in the general epilepsy population (MEDLINE search [[ssquote]66-10/5/01] indicates 35 publications; key words: weight loss and Topiramate), little is known about the frequency, benefits and permanence of weight loss in the elderly seizure population treated with Topiramate.
METHODS: Retrospective chart review of routine clinical care of patients taking Topiramate for the treatment of seizures in a VA epilepsy clinic. Sample consisted of veterans over the age of 50 who needed treatment with Topiramate for their epileptic seizures and were evaluated at the Neuro-Seizure clinic of the Audie L. Murphy VA hospital in San Antonio, TX. Titration schedule and dose modification was dictated by routine clinical care. However, the most common titration schedule used was to start with initial dose of 25mg at bedtime, and 25mg increases every other week using a twice-daily schedule until the clinically desired dose was achieved. Mean follow-up was 12.2 months
RESULTS: Topiramate was prescribed for 21 patients over the age of 50 who had epileptic seizures, most often, complex partial seizures. 14 patients were between ages 50-59, 2 patients were between ages 60-69, 3 patients were between ages 70-79, and 2 patients were over age 80 (Range: 50-81). Body mass index (BMI) was calculated using a weight obtained during the initial clinic visit when Topiramate was prescribed, and again at 3-5 months and 12-15 months after beginning treatment. 17 out of 21 patients reported taking Topiramate at the follow-up visits. Two of those 17 patients were excluded due to worsening of concomitant medical conditions unrelated to Topiramate treatment. One patient was diagnosed with colon cancer and malignant ascites. A second patient had a change in chemotherapy for pre-existent breast cancer. At 2nd follow-up, the 6 patients who had initial BMI over 30 (obese; range 31-39) had lost 3.26 BMI units (+/- 2.93 SEM). In contrast, 9 patients with initial BMI below 29 (range 23-29) only had lost an average of 0.55 BMI units (+/- 0.90 SEM). A one-tail t-test for the difference between these two small groups revealed p value of 0.05.
CONCLUSIONS: Topiramate was well tolerated in elderly epilepsy patients (81%) at one year, and it was associated with weight loss in seizure patients over the age of 50 who were overweight or obese. The weight loss was more significant in obese patients as compared to overweight patients at 12 months after starting Topiramate for seizure control. This is an interesting trend that deserves further study using a larger sample size and a prospective design.
(Disclosure: Grant - Johnson & Johnson Research Pharmaceutical Institute; NINDS, Consulting - Ortho-McNeil Pharmaceuticals)