Brief Overview:

Like zonisamide, there is only limited data in the scientific literature to support the use of topiramate (Topamax®) for treatment of infantile spasms. It is not recommended as a first-line treatment, but can be useful when added to other medications/therapies, and is often used when weaning off vigabatrin (Sabril®), steroids (e.g. prednisolone), or ACTH (ACTHar®). This medication is supplied as a tablet (which can be crushed) or a sprinkle-capsule which can be opened and whose contents can be mixed with liquid.


Typical dosage ranges from 3 to 15 mg/kg/day. This medication is usually administered twice daily. The length of a treatment course varies greatly among patients and practitioners, but is usually months in duration.

Side Effects:

Topiramate shares many side effects in common with zonisamide. In a minority of patients, this medication has been associated with drowsiness, diminished appetite, reduced sweating, and kidney stones. When present, drowsiness is usually mild and improves after several days/weeks of treatment. The same is true of effects on appetite. Reduced sweating is dangerous in the event of fever or high ambient temperatures. It is critical that patients—especially infants—not overheat, as prolonged hyperthermia (high body temperature) can lead to brain injury. In the event of diminished sweating, application of a wet washcloth to the brow is a useful substitute for sweating, so as to allow evaporation and cooling. You should contact your physician immediately in the event any of these side effects are observed or suspected.


This medication should be administered only under the direct supervision of a physician.

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