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The selection of an antiepileptic drug (AED) for any patient with epilepsy is difficult, but selecting one for an infant with epilepsy is especially challenging. Pediatric neurologists and epileptologists struggle with the dearth of data to guide the selection of an AED in this population. In addition, most of the available studies are not randomized controlled studies meeting the criteria of a class I study.1 The possibility that AEDs may injure the developing brain further complicates the issue.2
Topiramate is one of the more frequently prescribed antiepileptic drugs for infants,3 though class I trials to support this practice are lacking.4,5 One factor accounting for its use in infants is its efficacy in treating various types of epilepsy in older populations. Randomized controlled class I studies support its use as adjunctive therapy for adults and children with refractory partial and generalized epilepsy4 and as monotherapy for adults and children older than 2 years with new-onset partial and generalized epilepsy.6,7 Second, in contrast to those AEDs that traditionally have …
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