The Efficacy And Safety Of Topiramate As An Adjunctive Treatment For People With Refractory Epilepsy:A Meta Analysis

Objectives:To evaluate the efficacy and safety of topiramate(TPM)when used as an add-on treatment for people with refractory epilepsy,in order to provide evidence for clinical treatment of refractory epilepsy.Methods:A computer-based retrieval of Pubmed,Medline,Cochrane Library,CNKI,Wanfang Data knowledge service platform and Chinese biomedical literature database was conducted before September 2017.Search for literature about clinical randomized controlled trial of topiramate as an adjunctive treatment for people with refractory epilepsy,and manual retrieval and tracking of relevant references.Literature screening,quality evaluation and data extraction were carried out independently by two researchers.Finally,Meta analysis was carried out with Revman5.3 software.Results:11 randomized,double-blind,placebo-controlled trials with a total of 856 in topiramate group and 585 in placebo control group were finally included in the study.Mata analysis results show: A 50% or greater reduction in seizure frequency was significant in TPM group [OR=4.29,95%CI(2.81,6.53),P<0.00001].And we found that the main source of heterogeneity from TPM ?200mg group.A 75% or greater reduction in seizure frequency was significant in TPM group[OR=6.10,95%CI(2.95,12.60),P<0.00001].Seizure freedom was significant in TPM group[OR=4.19,95%CI(1.83,9.55),P=0.0007].Treatment withdrawal was significant in TPM group [OR=2.52,95%CI(1.67,3.79),P<0.0001].The common side effects included dizziness[OR=1.71,95%CI(1.21,2.41),P=0.002],fatigue OR=2.36,95%CI(1.55,3.58),P<0.0001],headache [OR=0.95,95%CI(0.66,1.36),P=0.79],somnolence[OR=2.49,95%CI(1.74,3.57),P<0.00001],weight loss[OR=4.60,95%CI(2.37,8.92),P<0.00001],difficulty with concentration[OR=8.91,95%CI(3.22,24.61),P<0.0001],paraesthesia [OR=4.02,95%CI(2.08,7.78),P < 0.0001],anorexia[OR=2.49,95%CI(1.41,4.37),P=0.002],vision abnormal [OR=2.56,95%CI(1.38,4.76),P=0.003].The occurrence rate of side effects in topiramate group was higher than that in control group but headache.Conclusion:1.Topiramate is effective in the treatment of refractory epilepsy.2.Patients receiving topiramate treatment were more likely to terminate the trial than those in the placebo group.3.Topiramate is more safe in the treatment of refractory epilepsy.Compared with the placebo group,common adverse reactions of patients receiving TPM include dizziness,fatigue,somnolence,weight loss,difficulty with concentration,paraesthesia,anorexia and vision abnormal.4.There was no difference in the incidence of headache between topiramate group and placebo group.