The role of hippocampal sclerosis in topiramate-related depression and cognitive deficits in people with epilepsy.
OBJECTIVE
To clarify the role of hippocampal sclerosis (HS) in developing psychiatric and cognitive adverse events during therapy with topiramate (TPM) in patients with temporal lobe epilepsy (TLE).


METHODS
We analyzed the data of 70 patients with TLE and HS and 128 patients with cryptogenic TLE matched for age, sex, starting dose, and titration schedule of TPM. They were selected from the first consecutive 431 patients started on TPM between 1995 and 1999.


RESULTS
Patients with HS were more likely to develop cognitive adverse events (CAEs; p = 0.002) and depression (p = 0.018) and to be receiving a polytherapy regimen (p = 0.007). However, regression analysis demonstrated that only HS was a predictive factor for the occurrence of CAEs (OR = 2.4; p < 0.001) and depression (OR = 2.3; p = 0.02).


CONCLUSIONS
Patients with TLE and HS were more prone to develop CAEs and depression than were patients with cryptogenic TLE, during TPM therapy, despite the same titration schedule. The presence of HS and not duration of epilepsy or polytherapy regimen represented the main risk factor.
Mula
Marco
M
Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, England, UK. marcomula@yahoo.it
Trimble
Michael R
MR
Sander
Josemir W A S
JW
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis; D003866:Depressive Disorder / Q000139:chemically induced* / Q000175:diagnosis; D004359:Drug Therapy, Combination; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012598:Sclerosis; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose