Nervous system adverse responses to topiramate in the treatment of neuropsychiatric disorders.
BACKGROUND
Nervous system adverse drug reactions (NS-ADRs), such as cognitive complaints and paresthesia, are among the most frequent and clinically important ADRs of topiramate. Studying ADR profiles across disorders is clinically relevant because treatment decision-making in neuropsychiatry is highly guided by ADR profiles.


METHODS
We used medline searches (until July 2009) to review the NS-ADRs of topiramate across the most investigated topiramate indications: alcohol dependence, essential tremor, binge-eating disorder, bulimia nervosa, migraine and epilepsy. We compared NS-ADRs between these disorders but did not carry out meta-analysis.


RESULTS
ADR profiles greatly differed between disorders. Drop-outs due to ADRs highly varied between disorders: from 2% in the bulimia nervosa group to 29% in the migraine group. Paresthesia was the most common NS-ADR for all disorders but frequencies also differed between disorders. Cognitive complaints were frequent and were reported in comparable proportions.


CONCLUSIONS
When prescribing topiramate in neuropsychiatry, physicians should be aware that NS-ADR profiles have been found to differ between disorders. Differences in drop-out rates due to ADRs and in frequencies of specific NS-ADRs across disorders must be taken into account when evaluating the potential harm of topiramate in clinical practice.
Luykx
Jurjen J
JJ
University Medical Center Utrecht, Department of Psychiatry, p/a Jurjen Luykx, PO Box 85500, 3508 GA Utrecht HP B01.206, The Netherlands. j.luykx@umcutrecht.nl
Carpay
Johannes A
JA
D001927:Brain Diseases / Q000188:drug therapy*; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D009422:Nervous System Diseases / Q000139:chemically induced*; D018696:Neuroprotective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D010292:Paresthesia / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D000077236:Topiramate
D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose