In 1999, Topamax (topiramate) was approved by the FDA to treat partial-onset seizures in children over 2 years of age. In 2001, it was approved to treat children with the Lennox-Gastaut syndrome. In both instances, it is recommended as an add-on (adjunctive) medication for children already taking another seizure medicine, but it can also be used alone. Doctors also commonly prescribe it (either as add-on therapy or alone) for children with primary generalized tonic-clonic seizures. Its effectiveness in treating children with myoclonic epilepsy is less well established, but evidence suggests that it can be useful for these children too.

If the dosage is increased slowly and carefully monitored, side effects should not be a problem for most children. The most common side effects involve problems with thinking or behavior, such as difficulty with concentration and attention or memory difficulty. These side effects may be less frequent in children than in adults. Headache, sleepiness, fatigue, and weight loss are other common side effects. Children are also susceptible to the rare visual problem (glaucoma) that was reported in 2001. Call the doctor immediately if the child experiences vision problems or eye pain.

Children often have the fewest problems from side effects with Topamax if they start at a dose of 15 to 25 milligrams (mg) or less, based on a range of 1 to 3 mg per kilogram (kg, about 2.2 pounds) of body weight per day. This dose is given nightly for the first week. The dose should then be increased every week or two by adding 1 to 3 mg per kg per day (given in two divided doses) to achieve the best response. Most children do best at about 5 to 9 mg per kg per day.

One advantage of using Topamax for children is that it comes in the form of a sprinkle capsule, which can be swallowed whole or given by carefully opening the capsule and sprinkling the entire contents on a small amount (teaspoon) of soft food. This mixture should be swallowed immediately and not chewed. See How to take and store Topamax (part of the Introduction) for details.

Children should be monitored in hot weather to be sure they sweat appropriately. Topamax impairs sweating in a few children, leading to high body temperatures.

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