Topiramate (Topamax) became available in 1997. Its mechanism of action is uncertain, but it appears to be effective in preventing propagation of the seizure from its focus. The half-life is 19 to 23 h, and 85 percent of the drug is eliminated unchanged through the renal system. The remaining 15 percent is metabolized by P-450 hepatic metabolism. With the relatively long half-life, the drug is given in a twice-daily dosage. It is indicated in the treatment of partial seizures and is being evaluated as monotherapy. In children, the drug is begun slowly at 1 mg/kg/day and over 8 to 12 weeks is gradually increased to a maximum of 10 mg/kg/day or 400 mg/day if necessary. The major side effect limiting dosage and rate of incrementing dosage is the effect on memory and name recall.

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