A Pharmacological and Clinical Review on Topiramate, a New Antiepileptic Drug

Perucca, Emilio

doi:10.1006/phrs.1997.0124

Cited by 156 publications

(102 citation statements)

References 39 publications

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“…It is largely excreted by the kidneys, although a small proportion is metabolized in the liver (5). TPM administration may reduce phenytoin clearance in some patients by selective inhibition of isoform 2C19 of the cytochrome P450 super family, but it has no effect on the concentrations of other AEDs (6). Enzyme-inducing AEDs, such as phenytoin and carbamazepine, accelerate the metabolism of TPM, lowering plasma concentrations by 40%.…”

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confidence: 99%

Topiramate in Refractory Epilepsy: A Prospective Observational Study

2000

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Summary:Purpose: This prospective observational study explored the efficacy and tolerability of topiramate (TPM) in patients with refractory epilepsy attending a single outpatient clinic.Methods: One hundred seventy patients (82 men, 88 women, aged 18-75 years) with refractory localization-related (n = 134) or idiopathic generalized epilepsy (n = 36) were started on adjunctive TPM using a standard titration schedule. TPM was introduced after a 3-month prospective baseline, and doses were adjusted according to clinical response. End points were seizure freedom for 6 months, 250% seizure reduction for 6 months compared with baseline at the highest tolerated TPM dose (responder), or discontinuation of TPM because of side effects, lack of efficacy, or both.Results: Thirty-nine (23%) patients were seizure-free, and 80 (47%) more patients had a useful therapeutic response. Thirteen seizure-free patients and 16 responders took 100 mg of TPM daily or less. TPM was discontinued in 51 (30%) patients. The most common side effects resulting in withdrawal were fatigue, weight loss, irritability, paresthesia, depression, and headache. Concomitant antiepileptic drugs (AEDs) were stopped in 30 patients. Twelve were established on TPM monotherapy, eight of whom remained seizure-free. Final TPM doses and concentrations varied widely among the three outcome groups.Conclusions: TPM was efficacious as add-on and monotherapy in patients with refractory partial and generalized seizures in everyday clinical use. A good response was obtained in many patients with TPM doses substantially lower than those studied in regulatory clinical trials. The wide variation in doseresponse and dose-toxicity relationships may reflect different neurobiologies causing refractory epilepsy and differential efficacy of AED combinations.

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confidence: 99%

Topiramate in Refractory Epilepsy: A Prospective Observational Study

2000

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“…Its manner of action is multimodal and involves blockage of voltage-gated sodium channels, potentiation of GABA-ergic transmission and inhibition of excitatory glutametergic pathways through an action at the AMPA receptor site. 28 Neuropsychiatric manifestations in the form of psychosis, affective disorders and behavioural disorders have emerged in patients on topiramate, vigabatrin and tiagabine. Trimble and Rusch 29 carried out a retrospective case study on 89 patients who developed behavioural symptoms during treatment with topiramate, vigabatrin and tiagabine.…”

Section: Discussionmentioning

confidence: 99%

Alternative psychosis (forced normalisation) in epilepsy

Ntsanwisi¹,

Rataemane

Magazi

2011

S. Afr. J. Psych.

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Forced normalization is a paradoxical relationship between seizure activity and behavioural problems. A 20 year old male with recurrent refractory tonic clonic epilepsy experienced forced normalization, whilst on medication with multiple anti- epileptic drugs (AEDs).(Valproate Sodium, Carbamazepine, and Topiramate). A reduction in the seizure burden correlated with sudden behavioural changes manifesting with aggressive outbursts and violence.. The present case may help clarify the mechanism of forced normalization whilst providing some helpful hints regarding the diagnosis and treatment of symptoms observed in recurrent refractory seizures.

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“…Topiramate: Topiramate has multifactorial action and involves blockade of voltage-dependent sodium channels, potentiation of GABAergic transmission and inhibition of excitatory pathways through an action at AMPA receptor sites [27]. Topiramate is effective in the treatment of moderate to severe essential tremor (Level B).…”

Section: Criteria For Possible Etmentioning

confidence: 99%

Essential Tremor: A Comprehensive Overview

Shah¹

2017

Journal of Neurological Disorders

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A Pharmacological and Clinical Review on Topiramate, a New Antiepileptic Drug

Cited by 156 publications

References 39 publications

Topiramate in Refractory Epilepsy: A Prospective Observational Study

Topiramate in Refractory Epilepsy: A Prospective Observational Study

Alternative psychosis (forced normalisation) in epilepsy

Essential Tremor: A Comprehensive Overview

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