PMID- 34817852
OWN - NLM
STAT- MEDLINE
DCOM- 20211206
LR  - 20230216
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 11
IP  - 11
DP  - 2021 Nov 24
TI  - Topiramate for juvenile myoclonic epilepsy.
PG  - CD010008
LID - 10.1002/14651858.CD010008.pub5 [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 2019. 
      OBJECTIVES: To evaluate the efficacy and tolerability of topiramate in the 
      treatment of JME. SEARCH METHODS: For the latest update, we searched the Cochrane 
      Register of Studies (CRS Web) on 26 August 2021, and MEDLINE (Ovid 1946 to 26 
      August 2021). CRS Web includes randomized or quasi-randomized controlled trials 
      from PubMed, Embase, ClinicalTrials.gov, the World Health Organization 
      International Clinical Trials Registry Platform (ICTRP), the Cochrane Central 
      Register of Controlled Trials (CENTRAL), and the Specialized Registers of 
      Cochrane Review Groups, including Cochrane Epilepsy. 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 of the studies. 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 greater reduction in primarily 
      generalized tonic-clonic seizures (PGTCS), compared with participants in the 
      placebo group (RR 4.00, 95% CI 1.08 to 14.75; 1 study, 22 participants; very 
      low-certainty evidence). There were no significant differences between topiramate 
      and valproate for participants responding with a 50% or greater reduction in 
      myoclonic seizures (RR 0.88, 95% CI 0.67 to 1.15; one study, 23 participants; 
      very-low certainty evidence) or in PGTCS (RR 1.22, 95% CI 0.68 to 2.21; one 
      study, 16 participants, very-low certainty evidence), or participants becoming 
      seizure-free (RR 1.13, 95% CI 0.61 to 2.11; one study, 27 participants; very-low 
      certainty evidence). Concerning tolerability, we ranked AEs associated with 
      topiramate as moderate to severe, while we ranked 59% of AEs linked to valproate 
      as severe complaints (2 studies, 61 participants; very low-certainty evidence). 
      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 the studies to be 
      at low to unclear risk of bias for the remaining domains (selection bias, 
      performance bias, detection bias and other bias). We judged the overall certainty 
      of the evidence for the outcomes as very low using the GRADE approach. AUTHORS' 
      CONCLUSIONS: We have found no new studies since the last version of this review 
      was published in 2019. 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.
CI  - Copyright (c) 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
FAU - Liu, Jia
AU  - Liu J
AD  - Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 
      100070 Beijing, China.
FAU - Tai, Yao-Jun
AU  - Tai YJ
AD  - Department of Neurology, Jiaozhou Hospital Affiliated to Dongfang Hospital, 
      Shangdong, China.
FAU - Wang, Lu-Ning
AU  - Wang LN
AD  - Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20211124
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. 2019 Jan 28;1:CD010008. PMID: 30687937
MH  - Anticonvulsants/adverse effects
MH  - Humans
MH  - *Myoclonic Epilepsy, Juvenile/drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Seizures/drug therapy
MH  - Topiramate/adverse effects
MH  - Valproic Acid/adverse effects
PMC - PMC8612308
COIS- Jia Liu: none known Yao-Jun Tai: none known Lu-Ning Wang: none known
EDAT- 2021/11/25 06:00
MHDA- 2021/12/15 06:00
PMCR- 2022/11/24
CRDT- 2021/11/24 12:32
PHST- 2021/11/24 12:32 [entrez]
PHST- 2021/11/25 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2022/11/24 00:00 [pmc-release]
AID - CD010008.pub5 [pii]
AID - 10.1002/14651858.CD010008.pub5 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2021 Nov 24;11(11):CD010008. doi: 
      10.1002/14651858.CD010008.pub5.