Topiramate and psychiatric adverse events in patients with epilepsy.
OBJECTIVE
The aim of this study was to determine the prevalence of psychiatric adverse events (PAEs) in patients with epilepsy treated with topiramate (TPM). Classification, relation to TPM dosing, and outcome were evaluated to identify a patient profile at risk of developing PAEs.


METHODS
We evaluated the data of the first consecutive and prospectively collected patients in therapy with TPM.


RESULTS
Follow-up information was available for 431 patients. PAEs occurred in 103 (23.9%) patients; M/F ratio, 55:48; mean age (+/-SD), 36.5 +/- 11.2. In 46 (10.7%) patients, an affective disorder developed; in 16 (3.7%), a psychotic disorder; in 24 (5.6%), aggressive behavior with or without irritability; in 17 (3.9%), other behavior abnormalities such as agitated behavior, anger/hostility behavior, or anxiety. High starting dose and rapid titration schedule were relevant for the development of PAEs. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic-atonic seizures were found to be significant risk factors. Low seizure frequency before starting TPM and TPM/lamotrigine coadministration had a protective effect for PAEs.


CONCLUSIONS
We found that PAEs associated with TPM were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.
Mula
Marco
M
Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Trimble
Michael R
MR
Lhatoo
Samden D
SD
Sander
Josemir W A S
JW
D000328:Adult; D000342:Affective Symptoms / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000188:drug therapy*; D017029:Epilepsy, Complex Partial / Q000139:chemically induced / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005632:Fructose / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D011446:Prospective Studies; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000523:psychology; D012307:Risk Factors; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose