DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20191106

Adverse effects of topiramate in patients with epilepsy in a tertiary care hospital: observational study

Subahan S. P., Kulandaiammal M., Arunan S.

Abstract


Background: Epilepsy is a common chronic neurological disorder characterized by paroxysmal cerebral dysrhythmia. Conventional antiepileptic drugs such as Phenytoin, carbamazepine, phenobarbitone and sodium valproate, have been proven to have good therapeutic effects. There are currently more than 10 different adjuvants which are approved for use in epileptics. Topiramate, a second-generation antiepileptic drug, is being used for several types of partial-onset and generalized-onset seizures. Effective treatment of epilepsy depends on medication compliance. The incidence of adverse effects is an important issue when antiepileptic drugs are prescribed to treat epilepsy. This study was done in Department of Neurology to observe the adverse effects of Topiramate in patients with epilepsy in a Tertiary care hospital.

Methods: For this study 100 patients receiving topiramate as an adjuvant drug along with regular anti epileptic drugs were enrolled in the study for prescheduled three months. Data of the patients were collected.

Results: In this study we observed that paresthesia (31%) was the commonly noted adverse effect followed by cognitive impairment (24%), sleepiness (19%), nausea (13%), anorexia (9%) and weight loss (4%).

Conclusions: Topiramate is a potent antiepileptic drug effective against most seizure types and has relatively favourable pharmacokinetic profile. It is appropriate for initial monotherapy as well as for adjuvant therapy in refractory patients. The major problem limiting its use is the frequent occurrence of cognitive adverse effects, especially expressive language dysfunction, which are reversible upon discontinuation of the medication.


Keywords


Antiepileptic drugs, Adverse effects, Epilepsy, Topiramate

Full Text:

PDF

References


Arroyo S, Dodson WE, Privitera MD (2005) Randomized dose controlled study of topiramate as first-line therapy in epilepsy. Acta Neurol Scand. 2005;112:214-22.

Sommer BR, Mitchell EL, Wroolie TE. Topiramate: effects on cognition in patients with epilepsy, migraine headache and obesity. Therapeutic advances in neurological disorders. 2013 Jul;6(4):211-27.

Lee S, Sziklas V, Andermann F, Farnham S, Risse G, Gustafson M, et al. The effects of adjunctive topiramate on cognitive function in patients with epilepsy. Epilepsia. 2003 Mar;44(3):339-47.

Thompson PJ, Baxendale SA, Duncan JS, Sander JW. Effects of topiramate on cognitive function. J Neurol Neurosurg Psychiatry. 2000 Nov 1;69(5):636-41.

Van Passel L, Arif H, Hirsch LJ. Topiramate for the treatment of epilepsy and other nervous system disorders. Expert Rev Neurotherapeut. 2006 Jan 1;6(1):19-31.

Jones MW. Topiramate-safety and tolerability. Canadian J Neurol Sci. 1998 Aug;25(S3):S13-5.

Faught E, Wilder BJ, Ramsay RE, Reife RA, Kramer LD, Pledger GW, et al. Topiramate placebo-controlled dose-ranging trial in refractory partial epilepsy using 200-, 400-, and 600-mg daily dosages. Neurol. 1996 Jun 1;46(6):1684-90.

Porter RJ, Rogawski MR. Antiseizure Drugs. In:Bertram G. Katzung’s The Basic and Clinical Pharmacology. 14th ed. New Delhi, NY:Lange; 2018:427-428.

Misty D. Smith, Cameron S. Metcalf, and Karen S. Wilcox. Pharmacotherapy of the Epilepsies. In: Brunton LB, Randa Hilal-Dandan, C. Knollmann, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill; 2018:318-319.

Reife R, Pledger G, Wu SC. Topiramate as add‐on therapy: pooled analysis of randomized controlled trials in adults. Epilepsia. 2000 Jan;41:66-71.

Tatum IV WO, French JA, Faught E, Morris III GL, Liporace J, Kanner A, et al. Postmarketing experience with topiramate and cognition. Epilepsia. 2001 Sep;42(9):1134-40.

Bootsma HP, Coolen F, Aldenkamp AP, Arends JB, Diepman L, Hulsman JA, et al. Topiramate in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center. Epilepsy Behavior. 2004 Jun 1;5(3):380-7.

Biton V, Edwards KR, Montouris GD, Sackellares JC, Harden CL, Kamin M, Topiramate TPS-TR Study Group. Topiramate titration and tolerability. Ann Pharmacotherapy. 2001 Feb;35(2):173-9.

Dodson WE, Kamin M, Kraut L, Olson WH, Wu SC. Topiramate titration to response: analysis of individualized therapy study (TRAITS). Ann Pharmacoth. 2003 May;37(5):615-20.

Naritoku DK, Hulihan JF, Schwarzman LK, Kamin M, Olson WH. Effect of cotherapy reduction on tolerability of epilepsy add-on therapy: a randomized controlled trial. Ann Pharmacoth. 2005 Mar;39(3):418-23.

Dodgson SJ, Shank RP, Maryanoff BE. Topiramate as an inhibitor of carbonic anhydrase isoenzymes. Epilepsia. 2000 Jan;41:35-9.