Epilepsy is a chronic neurological disease characterized by recurrent seizures and is caused by abnormal electrical activity in neuronal circuits. Refractory status epilepticus is a life-threatening condition that does not respond to first- and second-line anticonvulsant medications. Topiramate is a powerful antiseizure medication that is used in various types of epilepsy. This study aimed to investigate the effect of topiramate in treatment of refractory status epilepticus.
We have developed search strategies to identify articles related to the effect of topiramate on refractory status epilepticus. Our searches encompassed validated databases, including PubMed / MEDLINE, Scopus, Google Scholar and Cochrane Library, from 2012 to May 2026.
Of the 896 articles found in the preliminary search, 10 clinical studies were selected for structured review.  The results of this study showed that refractory status epilepticus occurs in about 38% of patients with status epilepticus and causes more mortality and disability. Acute symptomatic seizures tend to be resistant to treatment. Topiramate treatment ameliorated epileptic seizures in 194 cases out of 317 patients. Adverse effects, including pancreatitis and metabolic acidosis, and allergic reactions have been reported in rare cases. In conclusion, the available evidence suggests that topiramate may be a potentially useful adjunctive therapy for refractory status epilepticus, especially when administered early. However, reported studies are limited and most of them are based on observational data. Further well-designed prospective studies are required to evaluate its efficacy and safety.