Courchia B, Kurtom W, Pensirikul A, Del-Moral T, Buch M.
Topiramate for Seizures in Preterm Infants and the Development of
Necrotizing Enterocolitis. Pediatrics. 2018 Jun 14. pii: e20173971. doi:
10.1542/peds.2017-3971. [Epub ahead of print]
Abstract
Neonatal seizures represent a significant health burden on
the term and preterm neonatal population and are linked to poor long-term
neurodevelopmental outcomes. Currently, there are no US Food and Drug
Administration-approved antiepileptic drugs for neonates, and authors of the
medical literature have yet to reach a consensus on the most adequate approach
to neonatal seizures. Topiramate is readily used in the adult and older
pediatric population for the management of migraines and partial-onset
seizures. Topiramate continues to gain favor among pediatric neurologists who
often recommend this medication as a third-line treatment of neonatal seizures.
We report our recent experience with 4 preterm neonates, born between 2015 and
2017, who developed radiographic signs of necrotizing enterocolitis after
receiving topiramate for seizures. Each was given oral topiramate for the
treatment of electrographic and clinical seizures and developed the subsequent
diagnosis of necrotizing enterocolitis, with abdominal distention,
hemoccult-positive stools, and radiographic signs of intestinal distention and
pneumatosis. More research regarding the risk factors of topiramate use in
premature infants is needed.
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Writing in Pediatrics, online June 14, the authors note the
lack of consensus on how to treat neonatal seizures and that in cases of
uncontrolled seizures, adding topiramate to therapy with two antiepileptic
drugs is "controversial." Nonetheless, they point out, topiramate is
commonly recommended by pediatric neurologists as a tertiary medication in
neonates.
Corresponding author Dr. Benjamin Courchia told Reuters
Health by e-mail, "We are concerned by articles reporting a significant
increase in the use of topiramate for neonatal seizure in preterm
infants."
He called the lack of scientific evidence in favor of
topiramate use "striking" and said the authors hope their report, in
addition to spurring further research, will "give clinicians pause, to
weigh the risks and benefits of prescribing a medication without adequate data
regarding safety and efficacy in premature infants."
His team notes that although gastrointestinal side effects
of topiramate in adults had been described, "The temporal association
between the usage of topiramate and NEC has not been reported previously."
In addition, the researchers believe theirs is the only
report of topiramate use in premature infants for the treatment of seizures.
The infants were all managed at Holtz Children's Hospital,
Miami, between 2015 and 2017. All 10 infants (half female) were born at less
than 37 weeks gestation. Birth weights ranged from 440 g to 2,100 g.
The authors noted that the 40% incidence of NEC in this case
series contrasted with their hospital's baseline NEC rate of 5.8% over about
the same period.
They also cautioned that because these neonates had multiple
risk factors for NEC, the association with topiramate use might not have been
causal.
"Seizures are more common in the neonatal period than
in any other time throughout life" and are associated with poor outcome,
Dr. Ronit Pressler, a consultant in clinical neurophysiology at Great Ormond
Street Hospital for Children, London, told Reuters Health in an email.
https://www.medscape.com/viewarticle/898300
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