Fechner A, Hubert K, Jahnke K, et al. - In this multicenter study, researchers evaluated the usage of, the effectiveness of, and tolerability to topiramate (TPM) in patients with refractory SE (RSE) and superrefractory SE (SRSE). To detect TPM administration in SE patients treated in Frankfurt and Marburg between 2011 and 2016, a review of medical records was conducted. A total of TPM was used in 106 of 854 individuals having a mean age of 67.4 ± 18.1 years, 61 of whom were female. From SE onset to TPM initiation, the median latency was 8.5 days. SE patients had earlier failed a median of five other antiepileptic drugs. Data reported that the intrahospital mortality rate was 22.6%. Due to the late treatment position of TPM and the treatment latency of more than 8 days, the SE cessation rate attributed to TPM treatment (27.4%) is a relevant response. TPM can be considered an alternative option for treating RSE and SRSE based on these outcomes and in line with the findings of other case series. Hyperammonemia was a common adverse event in 38 patients (35.8%), particularly in conjunction with valproate administration.