Experience with topiramate monotherapy in elderly patients with recent-onset epilepsy

Objectives - To evaluate the effect of topiramate in elderly patients with onset of epilepsy after the age of 60, treatment-naive or non-responding to an initial antiepileptic drug. Methods - Analysis of patients with epilepsy diagnosed in the preceding 5 years, aged >= 65 years (n = 43), enrolled in a larger open-label trial (n = 692). After titration to topiramate 100 mg/day over 4 weeks, the dose was adjusted according to individual response (maximum 400 mg/day). Patients were followed up for at least 7 months. Results - After 7 months, 79% of patients remained in the study. Seizure frequency decreased significantly vs baseline (P < 0.001); >= 50% reduction in seizure frequency was achieved in 87% of patients, 64% remained seizure-free. Both previously treated and naive patients responded. Fourteen per cent dropped out because of insufficient tolerability. No unexpected or unusual adverse events were observed. Conclusion - The results indicate that elderly patients respond well to topiramate monotherapy. The high patient retention rate reflects a favourable tolerability profile in this population.