title: Zonisamide for migraine prophylaxis in topiramate-intolerant patients: an observational study.
abstract: BACKGROUND
  Zonisamide, a sulfonamide analog, is an antiepileptic drug with mechanisms of action similar to topiramate. Because of its pharmacodynamic and pharmacokinetics profiles, zonisamide is also potentially suitable for migraine prevention.
  
  
  METHODS
  Tolerability and effectiveness of zonisamide for migraine prophylaxis in patients with a good response to topiramate, but interrupting it for intolerable side effects, were evaluated in 34 patients. After a 1-month period of wash-out, patients were treated with zonisamide (up to a 100 mg/day dosage) for 6 consecutive months.
  
  
  RESULTS
  Zonisamide was well tolerated, only 4 (12%) patients reported transient and tolerable side effects. Mean number of days with headache per month was reduced from 14.9 ± 5.3 during the wash-out period to 2.5 ± 0.6 after 6 months of zonisamide (P < .001). We observed a significant reduction in headache severity and disability, as assessed by visual analog scale and migraine disability assessment scale. Finally, when compared with the 1-month period prior to starting zonisamide, a reduced use of analgesics was recorded at the end of the follow-up.
  
  
  CONCLUSIONS
  Our findings support the use of zonisamide as an alternative therapy for migraine prevention in patients with good response, but poor tolerance to topiramate.
authors.affiliation: Neurology Headache Centre, S. Andrea Hospital, Sapienza University, Rome, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Villani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ciuffoli
authors.forename: Luca
authors.initials: L
authors.lastname: Prosperini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Sette
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007555:Isoxazoles / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000517:prevention & control*; D019964:Mood Disorders / Q000139:chemically induced; D010292:Paresthesia / Q000139:chemically induced; D011446:Prospective Studies; D012720:Severity of Illness Index; D000077236:Topiramate; D016896:Treatment Outcome; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D007555:Isoxazoles; D000077236:Topiramate; D005632:Fructose; D000078305:Zonisamide