Topiramate add-on for drug-resistant partial epilepsy
Bibliographic record
Abstract
BACKGROUND: The majority of people with epilepsy have a good prognosis and their seizures are controlled by a single antiepileptic drug. However, up to 30 per cent develop drug-resistant epilepsy, especially those with partial onset seizures. In this review we summarize the current evidence regarding a new antiepileptic drug, topiramate, when used as an add-on treatment for drug resistant partial epilepsy. OBJECTIVES: To evaluate the effects of topiramate when used as an add-on treatment for drug-resistant partial epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's specialized register (28 March 2002); the Cochrane Controlled Trials Register (Cochrane Library Issue 1, 2002). In addition, we contacted Johnson and Johnson (makers of topiramate) and experts in the field to seek any ongoing or unpublished studies. SELECTION CRITERIA: Randomized placebo controlled add-on trials of topiramate recruiting people with drug-resistant partial epilepsy. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted the relevant data. The following outcomes were assessed: (a) 50 per cent or greater reduction in seizure frequency; (b) treatment withdrawal (any reason); (c) side effects. Primary analyses were intention-to-treat. Summary relative risks (RR) with 95% confidence intervals (95% CI) are presented. Dose response was evaluated in regression models. MAIN RESULTS: Nine trials were included representing 1049 randomized participants. The RR for a 50 per cent or greater reduction in seizure frequency compared to placebo was 3.32(95% CI 2.52 to 4.39). Dose regression analysis shows increasing effect with increasing dose, but found no advantage for doses over 300 mg per day. The RR for treatment withdrawal compared to placebo was 2.06(95% CI 1.38 to 3.08). The RR for the following side effects indicate that they are significantly associated with topiramate: 1.95(99% CI 1.04 to 3.65), dizziness 1.55(99% CI 1.07 to 2.24); fatigue 2.21(99% CI 1.42 to 3.45); nausea 2.75(99% CI 1.36 to 5.57); somnolence 2.26(99% CI 1.48 to 3.46) and 'thinking abnormally' 5.54(99% CI 2.34 to 13.12). REVIEWER'S CONCLUSIONS: Topiramate has efficacy as an add-on treatment for drug-resistant partial epilepsy. However, trials reviewed were of relatively short duration, and provide no evidence for the long term efficacy of topiramate. Results cannot be extrapolated to monotherapy or treating other epilepsy types.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.025 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.021 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".