title: The effects of topiramate therapy on cerebral metabolism in migraine with aura patients.
abstract: OBJECTIVE
  Topiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment.
  
  
  METHODS
  We included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.
  
  
  RESULTS
  Basal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05).
  
  
  CONCLUSIONS
  Topiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control.
authors.affiliation: Erzincan Military Hospital, Neurology Service, Erzincan, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Karadas
authors.forename: Hakan Levent
authors.initials: HL
authors.lastname: Gul
authors.forename: Bilgin
authors.initials: B
authors.lastname: Ozturk
authors.forename: Erdal
authors.initials: E
authors.lastname: Eroglu
authors.forename: Seref
authors.initials: S
authors.lastname: Demirkaya
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D054022:Cerebrum / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology*; D020325:Migraine with Aura / Q000188:drug therapy* / Q000503:physiopathology; D020769:Posterior Cerebral Artery / Q000502:physiology*; D011187:Posture; D000077236:Topiramate; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose