title: Topiramate: A Novel Therapeutic Candidate for Diabetes and Aggression? Positron Emission Tomography (PET) Findings.
abstract: BACKGROUND
  There is still limited knowledge regarding the role of impaired brain glucose metabolism in the generation of aggression during diabetes. Additionally, there are rapidly replicating piece of evidence suggesting that topiramate may exert significant mood stabilizing effect. In this respect, we aimed to evaluate the neurometabolic correlates of the therapeutic effect of topiramate in a patient with diabetes and Intermittent explosive disorder (IED).
  
  
  METHODS
  We measured regional cerebral glucose metabolism using 2-[18F]-fluoro-2-deoxy-D-glucose and positron emission tomography (FDG-PET) in a diabetic patient with aggressive outbursts before and after treatment with topiramate. In order to reveal a defined information underlying the improvement of the aggressive symptoms we also combined the PET with Modified Overt Aggression Scale.
  
  
  RESULTS
  We have found that topiramate leads to the improvement in Modified Overt Aggression Scale that was well correlated with the increase in cortical brain metabolism.
  
  
  CONCLUSIONS
  The therapeutic role of topiramate may not only suggest secondary deficits due to diminished functions of the cortical part of emotional circuits but also indicate that diabetic individuals may be vulnerable to lower cerebral glucose metabolism in cortical regions. Further clinical trials that include well-conducted randomized controlled trials and cohort studies by using other methods (i.e., magnetic resonance spectroscopy and quantitative EEG analysis) are necessary to confirm our preliminary findings.
authors.affiliation: Department of Neurology University of Istanbul-Medipol, Istanbul, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Yulug
authors.forename: Lütfü
authors.initials: L
authors.lastname: Hanoglu
authors.forename: Ahmet Mithat
authors.initials: AM
authors.lastname: Tavli
authors.forename: Tansel
authors.initials: T
authors.lastname: Cakir
authors.forename: Oktay
authors.initials: O
authors.lastname: Olmuscelik
authors.forename: Burak
authors.initials: B
authors.lastname: Pakoz
authors.forename: Gülşen
authors.initials: G
authors.lastname: Ünlü
mesh_terms: D000328:Adult; D000374:Aggression / Q000187:drug effects* / Q000502:physiology; D000818:Animals; D001921:Brain / Q000000981:diagnostic imaging* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005632:Fructose / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D000077236:Topiramate
chemical_list: D000077236:Topiramate; D005632:Fructose