Topiramate cognitive effects

The cognitive effects of topiramate and valproate as adjunctive therapy to carbamazepine have been compared in 53 patients (637). Topiramate was given in an initial dose of 25 mg and increased weekly by 25 mg/day increments to a minimum of 200 mg/day. Cognition was significantly worsened by topiramate and improved by valproate. Gradual introduction of topiramate reduced the extent of cognitive impairment. 

Martin R, Kuzniecky R, Ho S, et al. Cognitive effects of topiramate, gabapentin and lamotrigine in healthy young adults. Neurology 1999 52 321-327. 

Pandina GJ, Ness S, Polverejan E, Yuen E, Eerdekens M, Bilder RM, Ford L. Cognitive effects of topiramate in migraine patients aged 12 through 17 years. Pediatr Neurol 2010 42(3) 187-95. 

Psychological The cognitive effects of topiramate have been explored in two small studies. 

The cognitive effects of levetiracetam and topiramate have also been evaluated in a blinded but non-randomized study in 79 patients with intractable epilepsy [312 ]. Assessments were done at baseline and after 1 year of treatment using the Cognitive Abilities Screening Instrument. There were no relevant differences between the two drugs. 

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. 

Risperidone has also been used in combination with topiramate in a Spanish multicenter study in 58 patients (28 men and 30 women mean age 41 years) with bipolar I disorder, with manic but not mixed episodes (20). Risperidone (mean dose 2.7 mg/day) and topiramate (mean dose 236 mg/day) were started with a maximum 48-hour time difference risperidone was used for acute manic symptoms and topiramate for longer-term stabilization and prevention of relapse. The incidence of any adverse event was 64%, mostly somnolence, paresthesia, dizziness, tremor, weight loss (n = 27 mean change -1.1 kg), extrapyramidal disorders, gastrointestinal effects, and cognitive disturbances. One patient developed tardive dyskinesia during the study and there were five dropouts because of adverse effects adverse effects that required withdrawal of risperidone but not topiramate were amenorrhea (n = 3) and sexual dysfunction (n = 1). 

The cognitive adverse effects of topiramate have been studied in 62 patients taking carbamazepine who had addon therapy with either topiramate, valproic acid, or... 

Thompson PJ, Baxendale SA, Duncan JS, Sander JW. Effects of topiramate on cognitive function. J Neurol Neurosurg Psychiatry 2000 69(5) 636 11. 

Aldenkamp AP, Baker G, Mulder OG, Chadwick D, Cooper P, Doelman J, Duncan R, Gassmann-Mayer C, de Haan GJ, Hughson C, Hulsman J, Overweg J, Pledger G, Rentmeester TW, Riaz H, Wroe S. A multicenter, randomized clinical study to evaluate the effect on cognitive function of topiramate compared with valproate as add-on therapy to carbamazepine in patients with partial-onset seizures. Epilepsia 2000 41(9) 1167-78. 

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. 

Meador KJ, Loring DW, Hulihan JF, Kamin M, Karim R CAPSS-027 Study Group. Differential cognitive and behavioral effects of topiramate and valproate. Neurology 2003 60 1483-8. 

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. 

In a 3-year retrospective review of the use of topiramate in 51 children aged 3-16 years with partial and generalized epilepsy, 15 children had a greater than 50% reduction in their seizure frequency and four became seizure free (4). Adverse effects were reported in 29 patients most were related to behavioral and cognitive difficulties less common effects included anorexia, weight loss, and headache. Topiramate was withdrawn in 25 patients in 20 cases because of adverse effects. 

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