title: Weight regain after discontinuation of topiramate treatment in patients with migraine: a prospective observational study.
abstract: OBJECTIVE
  To monitor weight regain after therapy discontinuation in patients with migraine experiencing weight loss during topiramate (TPM) treatment.
  
  
  METHODS
  Patients with migraine without aura were enrolled in this observational prospective study. Weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, and ghrelin, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated before starting TPM (T1), at 3 (T2) and 6 (T3) months of treatment and 6 months after withdrawal of TPM (T4). Weight loss/regain was considered as a change of </>5% of pre-TPM body weight.
  
  
  RESULTS
  A total of 241 patients were analyzed. Of these, 87 (36%) patients experienced weight loss on TPM medication. During TPM therapy significant reductions in mean values of weight (p<0.001), BMI (p<0.001), waist circumference (p<0.01), HOMA-IR (p<0.01), and leptin (p<0.01) were observed. After TPM discontinuation, all of these parameters showed a clear trend to increase at T4, achieving pre-TPM values in 27 patients. Among potential predictors, only HOMA-IR before starting TPM (parameter estimate=1.36, effect size=0.75; p=0.006) was significantly associated with weight regain after therapy discontinuation.
  
  
  CONCLUSIONS
  Loss of body weight is a reversible effect, which at 6 months after TPM discontinuation shows a clear trend to return to baseline values. HOMA-IR is the only predictive factor of weight regain.
authors: Department of Pediatrics, University of Perugia, Perugia, Italy.
authors: Alberto
authors: A
authors: Verrotti
authors: Pasquale
authors: P
authors: Parisi
authors: Sergio
authors: S
authors: Agostinelli
authors: Giulia
authors: G
authors: Loiacono
authors: Francesca
authors: F
authors: Marra
authors: Giangennaro
authors: G
authors: Coppola
authors: Laura Rosa
authors: LR
authors: Pisani
authors: Gaetano
authors: G
authors: Gorgone
authors: Pasquale
authors: P
authors: Striano
authors: Francesco
authors: F
authors: Pisani
authors: Vincenzo
authors: V
authors: Belcastro
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002491:Central Nervous System Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D020326:Migraine without Aura / Q000188:drug therapy / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D000077236:Topiramate; D055105:Waist Circumference; D015430:Weight Gain; D015431:Weight Loss / Q000187:drug effects; D055815:Young Adult
chemical_list: D002491:Central Nervous System Agents; D000077236:Topiramate; D005632:Fructose; D002784:Cholesterol
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