An audit of topiramate use in a general neurology clinic.
The purpose of this study was to look at the efficacy and side effect profile of topiramate in a neurology unit. Using case notes, 94 patients who had been treated with topiramate were identified: 48 patients had taken part in clinical trials of topiramate, 46 received topiramate once licensed. Of these patients 24% had a greater than 50% decrease in seizure frequency. Patients with primary generalized epilepsy (n = 12) had a greater reduction in seizures compared with those with partial epilepsies (n = 70) P > 0.03. There was a high incidence (41%) of side effects, particularly psychiatric problems, leading to withdrawal of therpay in 41% of patients. Seven patients were admitted to hospital as a result of psychotic symptoms or depression. The incidence of psychotic symptoms (12%) was significantly higher for patients receiving topiramate compared with 191 patients attending the department on gabapentin (0.5%) and 270 patients attending the department on lamotrigine (0.7%) P < 0.001. 'Abnormal thinking', consisting of mental slowing and word-finding difficulties, occurred in 31%. The incidence could be significantly reduced by using 25 mg dose increments fortnightly as opposed to 100 mg weekly (P > 0.03). Although topiramate is an effective antiepileptic drug, its use is accompanied by a high incidence of particularly psychiatric side effects.
Department of Neurosciences, York District Hospital, UK.
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Crawford
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D003071:Cognition / Q000187:drug effects; D003863:Depression / Q000139:chemically induced; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D008297:Male; D008485:Medical Audit; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data; D011605:Psychoses, Substance-Induced / Q000209:etiology; D012189:Retrospective Studies; D000077236:Topiramate; D006113:United Kingdom
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose