PMID- 30687937
OWN - NLM
STAT- MEDLINE
DCOM- 20190410
LR  - 20220830
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 1
IP  - 1
DP  - 2019 Jan 28
TI  - Topiramate for juvenile myoclonic epilepsy.
PG  - CD010008
LID - 10.1002/14651858.CD010008.pub4 [doi]
LID - CD010008
AB  - BACKGROUND: Topiramate is a newer broad-spectrum antiepileptic drug (AED). Some 
      studies have shown the benefits of topiramate in the treatment of juvenile 
      myoclonic epilepsy (JME). However, there are no current systematic reviews to 
      determine the efficacy and tolerability of topiramate in people with JME. This is 
      an update of a Cochrane Review first published in 2015, and last updated in 2017. 
      OBJECTIVES: To evaluate the efficacy and tolerability of topiramate in the 
      treatment of JME. SEARCH METHODS: For the latest update, on 10 July 2018 we 
      searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane 
      Epilepsy Group's Specialized Register and the Cochrane Central Register of 
      Controlled Trials (CENTRAL), MEDLINE (Ovid 1946- ), and ClinicalTrials.gov. We 
      also searched ongoing trials registers, reference lists and relevant conference 
      proceedings, and contacted study authors and pharmaceutical companies. SELECTION 
      CRITERIA: We included randomized controlled trials (RCTs) investigating 
      topiramate versus placebo or other AED treatment for people with JME, with the 
      outcomes of proportion of responders and proportion of participants experiencing 
      adverse events (AEs). DATA COLLECTION AND ANALYSIS: Two review authors 
      independently screened the titles and abstracts of identified records, selected 
      studies for inclusion, extracted data, cross-checked the data for accuracy and 
      assessed the methodological quality. We performed no meta-analyses due to the 
      limited available data. MAIN RESULTS: We included three studies with a total of 
      83 participants. For efficacy, a greater proportion of participants in the 
      topiramate group had a 50% or more reduction in primarily generalized 
      tonic-clonic seizures (PGTCS) compared with participants in the placebo group. 
      There were no significant differences between topiramate and valproate in 
      participants responding with a 50% or more reduction in myoclonic seizures or in 
      PGTCS, or becoming seizure-free. Concerning tolerability, we ranked AEs 
      associated with topiramate as moderate to severe, while we ranked 59% of AEs 
      linked to valproate as severe complaints. Moreover, systemic toxicity scores were 
      higher in the valproate group than the topiramate group.Overall we judged all 
      three studies to be at high risk of attrition bias and at unclear risk of 
      reporting bias. We judged all three studies to be at low to unclear bias for the 
      remaining risk of bias domains (random sequence, allocation, blinding). We judged 
      the quality of the evidence from the studies to be very low. AUTHORS' 
      CONCLUSIONS: We have found no new studies since the last version of this review 
      was published in 2017. This review does not provide sufficient evidence to 
      support topiramate for the treatment of people with JME. Based on the current 
      limited available data, topiramate seems to be better tolerated than valproate, 
      but has no clear benefits over valproate in terms of efficacy. Well-designed, 
      double-blind RCTs with large samples are required to test the efficacy and 
      tolerability of topiramate in people with JME.
FAU - Liu, Jia
AU  - Liu J
AD  - Department of Neurology, Xuanwu Hospital, Capital Medical University, Changchun 
      Street 45, Beijing, China, 100053.
FAU - Wang, Lu-Ning
AU  - Wang LN
FAU - Wang, Yu-Ping
AU  - Wang YP
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20190128
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticonvulsants)
RN  - 0H73WJJ391 (Topiramate)
RN  - 614OI1Z5WI (Valproic Acid)
SB  - IM
UOF - Cochrane Database Syst Rev. 2017 Apr 23;4:CD010008. PMID: 28434203
CIN - Dev Med Child Neurol. 2020 Aug;62(8):895-896. PMID: 32557590
UIN - Cochrane Database Syst Rev. 2021 Nov 24;11:CD010008. PMID: 34817852
MH  - Adolescent
MH  - Anticonvulsants/administration & dosage/adverse effects/*therapeutic use
MH  - Child
MH  - Humans
MH  - Myoclonic Epilepsy, Juvenile/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Seizures/drug therapy
MH  - Topiramate/adverse effects/*therapeutic use
MH  - Treatment Outcome
MH  - Valproic Acid/adverse effects/therapeutic use
MH  - Young Adult
PMC - PMC6353083
COIS- Jia Liu: none known
 Lu-Ning Wang: none known
 Yu-Ping Wang: none known
EDAT- 2019/01/29 06:00
MHDA- 2019/04/11 06:00
PMCR- 2020/01/28
CRDT- 2019/01/29 06:00
PHST- 2019/01/29 06:00 [pubmed]
PHST- 2019/04/11 06:00 [medline]
PHST- 2019/01/29 06:00 [entrez]
PHST- 2020/01/28 00:00 [pmc-release]
AID - CD010008.pub4 [pii]
AID - 10.1002/14651858.CD010008.pub4 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2019 Jan 28;1(1):CD010008. doi: 
      10.1002/14651858.CD010008.pub4.