Epilepsy topiramate

Angelman s syndrome, a genetic disorder that involves a defect in the DNA coding for subunits of the GABA-A receptor, is often associated with intractable epilepsy. Topiramate was effective in five children with Angelman s syndrome and epilepsy (645). One patient had transient insomnia and one had akathisia and insomnia that persisted until topiramate was withdrawn. 

Abou-Khalil B. Topiramate in the long-term management of refractory epilepsy. Topiramate YOL Study Group. Epilepsia 2000 41(Suppl l) S72-6. 

Witt JA, Eiger CE, Hehnstaedter C. Impaired verbal fluency imder topiramate-evidence for synergistic negative effects of epilepsy, topiramate, and polytherapy. Eur J Neurol January 2013 20(l) 130-7. 

Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

Myoclonic Not mentioned Lamotrigine Valproate Valproate Topiramate (children with severe myoclonic epilepsy of infancy) Second-line Clobazam6 Clonazepam Lamotrigine Levetiracetam Piracetam6 Topiramate... 

Topiramate is used to treat epilepsy in both children and adults. In children it is also indicated for... 

Fritz N, Glogau S, Hoffmann J, Rademacher M, Eiger CE, Helmstaedter C. Efficacy and cognitive side effects of tiagabine and topiramate in patients with epilepsy. Epilepsy Behav 2005 6(3) 373-81. 

Jette NJ, Marson AG, Hutton JL. Topiramate add-on for drug-resistant partial epilepsy. Cochrane Database Syst Rev 2002. 

Groselj 1, Fuerrini R, Van Oene I, et al. Experience with topiramate monotherapy in elderly patients with recent-onset epilepsy. Acta Neurol Scand 2005 i i2 i44-i50. 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

Ben-Menachem E et al Topiramate monotherapy in the treatment of newly or recently diagnosed epilepsy. Clin Ther 2008 30 1180. [PMID ... 

Waugh J, Goa KL. Topiramate as monotherapy in newly diagnosed epilepsy. CNS Drugs. 2003 17 985-992. 

Topiramate can be described as a broad-spectrum neurotherapeutic agent with multiple modes of action, and its weight-loss promoting activity came to attention in trials of therapy for epilepsy [104], and explored further in animal experiments [105, 106], It has also been successfully used in the treatment of obesity associated with eating disorders [107, 108], As specific weight-loss therapy in one short-term [109] and one long-term study [110] in non-diabetics without co-morbid neuropsychiatric conditions, topiramate has been shown to produce a modest dose-related benefit compared to placebo, and with a reasonable side-effect profile. 

Side effects. Many of the side effects reported to occur with topiramate have been found in patients receiving other antiepileptic drugs concurrently. Such side effects as ataxia, confusion, dizziness, fatigue, somnolence, memory disturbance, depression and agitation appear to be less frequent in those patients receiving topiramate as a monotherapy. Weight loss has been reported in many patients this effect may be due to drug induced anorexia. Topiramate has proven efficacious in the treatment of severe epilepsy. 

Vigabactin is indicated for second-line use in patients with refractory partial epilepsy but, unlike lamotrigine and topiramate, it does not appear to be useful in generalized epilepsies. It is the drug of choice for infantile spasms. 

A group of 14 US epilepsy centers has published the results of a post-marketing surveillance study of 701 patients taking topiramate (633). Although 41% of the patients reported cognitive adverse events at any time during treatment, only 5.8% of them discontinued for... 

A significant improvement in neuropsychological functions associated with the frontal lobe after withdrawal of topiramate in epilepsy patients was reported in an open controlled study (643). The results suggested that verbal fluency and working memory were very sensitive to topiramate. Improvement in this function was observed after withdrawal of topiramate but not in the control group. 

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

Daytime vigilance has been assessed in 14 newly diagnosed never medicated adults with focal epilepsy at baseline and 2 months after slow titration of topiramate to 200 mg/day (653). Multiple Sleep Latency Test (MSLT), visual simple and choice reaction time (VRT), and selfrating with the Epworth Sleepiness Scale were used for quantification of sleepiness, and compared with 14 healthy volunteers. At baseline MSLT scores were comparable. Two months after topiramate monotherapy, MSLT, VRT, and self-rating did not change significantly. 

Mohamed K, Appleton R, Rosenbloom L. Efficacy and tolerability of topiramate in childhood and adolescent epilepsy a clinical experience. Seizure 2000 9(2) 137-41. 

Meador KJ, Hulihan JF, Karim R. Cognitive function in adults with epilepsy effect of topiramate and valproate added to carbamazepine. Epilepsia 2001 42(Suppl 2) 75. 

Lee S, Sziklas V, Andermann F, Farnham S, Risse G, Gustafson M, Gates J, Penovich P, Al-Asmi A, Dubeau F, Jones-Gotman M. The effects of adjunctive topiramate on cognitive function in patients with epilepsy. Epilepsia 2003 44 339 17. 

Mula M, Trimble MR, Thompson P, Sander JW. Topiramate and word-finding difficulties in patients with epilepsy. Neurology 2003 60 1104-7. 

Kockelmann E, Eiger CE, Helmstaedter C. Significant improvement in frontal lobe associated neuropsychological functions after withdrawal of topiramate in epilepsy patients. Epilepsy Res 2003 54 171-8. 

Franz DN, Glauser TA, Tudor C, Williams S. Topiramate therapy of epilepsy associated with Angelman s syndrome. Neurology 2000 54(5) 1185-8. 

Bonanni E, Galli R, Maestri M, Pizzanelli C, Fabbrini M, Manca ML, Iudice A, Murri L. Daytime sleepiness in epilepsy patients receiving topiramate monotherapy. Epilepsia 2004 45(4) 333-7. 

Sudden unexplained deaths have occurred in epilepsy (unknown if related to topiramate use)... 

Ormrod D, McClellan K. Topiramate a review of its use in childhood epilepsy. Paediatr Drugs. 2001 3 293-319. 

Bromide (1857) was the first drug to be used for the treatment of epilepsy, but it is now obsolete. Phenobarbital, introduced in 1912, controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin (a hydantoin) which is structurally related to the barbiturates. Since then many other drugs have been discovered, but phenytoin still remains a drug of choice in the treatment of major epilepsy. Over the past ten years there has been a dramatic increase in the number of new anticonvulsant drugs (vigabatrin, gabapentin, lamotrigine, topiramate, oxcarbazepine, levetiracetam), but none has been shown to be superior to the major standard anticonvulsants (phenytoin, carbamazepine and sodium valproate). 

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