20 Sept 2023 • A lower dose of topiramate may be effective for seizure control in patients with epilepsy whose seizures are well controlled with topiramate monotherapy, according to study results presented at the annual meeting of the American Neurological Association. Researchers reviewed data from 396 patients with epilepsy who had undergone topiramate therapeutic drug monitoring at their institution. They collected clinical data on topiramate serum level, antiseizure medication regimens, seizure frequency, and adverse events.

• When analyzing antiseizure efficacy, the good-response group had a significantly lower topiramate dose compared with the partial-response group(113 versus 148 mg) and a significantly lower serum level (3.3 versus 4.7 mg/L).
• Researchers also noted that topiramate serum levels among patients under polypharmacy showed similar results. Ataxia was the only side effect showing dependency with serum level, with a level of >10 µg/mL associated with a significantly increased probability of ataxia.

“For patients whose seizures are well controlled with topiramate monotherapy, serum level of 3.3 mg/L may suffice,” the authors write. “Topiramate serum level above 10 mg/L increases risk of ataxia without incremental benefit of seizure control.”

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