Irritability topiramate

In a retrospective survey, behavioral changes occurred in nine of 69 children (median age 12 years) taking topiramate (634). Dosages in the affected children were 2.4— 8.5 mg/kg, and three children were taking monotherapy. Manifestations included school difficulties (635), mood swings (636), and aggression, irritability, and hallucinations (one case each). There was no apparent relation to dosage or titration rate. 

The efficacy and tolerability of topiramate have been studied in 170 patients with refractory epilepsy (7). The most common adverse effects resulting in withdrawal were fatigue, weight loss, irritability, paresthesia, depression, and headache. Three patients developed renal calculi but continued therapy. 

In the comparison of four anticonvulsants mentioned above, the commonest adverse effect of topiramate in 28 patients was irritability, which occurred in seven of ten patients who discontinued therapy because of adverse effects (18). 

A 16-month-old girl developed increasing irritability associated with topiramate it resolved promptly on withdrawal. Venous blood showed a metabohc acidosis. 

Mood stabilizers can be used as augmentation therapy in cases of partial response to antidepressant therapy, especially those with prominent irritability or anger. Anticonvulsants (thought to exert their mechanism in part through antikindling effects) have been effective in treating PTSD. In a retrospective review topiramate reduced nightmares and flashbacks. Divalproex sodium was effective in an open trial. ... 

Of 151 children with epilepsy, mean age 33 months, taking topiramate, 59 had symptoms related to hypohidrosis, such as facial flushing, lethargy, pruritus, irritability with hyperthermia, or heat intolerance [298 ]. 

Observational studies In a study of topiramate for intractable childhood generalized epilepsy with epileptic spasms, adverse effects were observed in 13 of 33 patients and included somnolence, anorexia, and irritability. Seizure aggravation was observed in six patients [16(P]. 

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