Topiramate--a cautionary note

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Posted by Bob Johnson ( on October 26, 2000 at 10:00:37:

This report is not a reason to panic and avoid using the med but it suggests that you may want to try one of the other preventive meds before trying topiramate.

Topiramate Therapy Linked to Decline in Cognitive Function

WESTPORT, CT (Reuters Health) Oct 26 - Results of a retrospective study indicate that treatment with the antiepileptic agent topiramate may have a negative effect on cognition, especially verbal processing.

Prompted by patient complaints, Dr. Pam J. Thompson and colleagues from University College London, UK, reviewed the neuropsychological test scores of 18 patients with intractable epilepsy obtained before and after the initiation of topiramate at a median dose 300 mg. They compared these scores with the scores of 18 matched patients who underwent neuropsychological assessment at similar time intervals.

In the November issue of the Journal of Neurology, Neurosurgery and Psychiatry, the researchers report that treatment with topiramate was "associated with impairments on tests of cognitive functioning, which were not seen in patients who were not taking this drug." Verbal IQ, verbal fluency and verbal learning were the areas most notably affected by topiramate treatment.

The researchers do not believe that the negative effects of topiramate on cognitive function represent acute effects because all of the patients had been taking the drug for at least 90 days. Furthermore, they say that "improvements seen in patients reassessed after topiramate had been withdrawn or reduced provides further support that the drug had been having a negative impact on cognition."

Dr. Thompson and colleagues say that while topiramate is "clearly" an effective antiepileptic, patients and their families should be given "explicit advice on potential adverse cognitive effects in the same way that candidates for epilepsy surgery are counseled on possible cognitive sequelae." They also recommend neuropsychological testing before and after topiramate treatment.

J Neurol Neurosurg Psychiatry 2000;69:636-641.

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