Language Disturbances as Side Effects of Topiramate and Zonisamide Therapy

Ojemann, L. M.; Ojemann, George A.; Dodrill, Carl B.; Crawford, Carol A. Gotway; Holmes, Mark; Dudley, Donald L.

doi:10.1006/ebeh.2001.0285

Cited by 67 publications

(53 citation statements)

References 15 publications

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“…The neuropsychological findings are largely confirmatory of what has been shown before (1)(2)(3)(4), and similar language-based fMRI results in patients on TPM have also been demonstrated previously (5)(6)(7). But in the current report the investigators OBJECTIVE: To investigate the effects of topiramate (TPM), zonisamide (ZNS), and levetiracetam (LEV) on cognitive network activations in patients with focal epilepsy using an fMRI language task.…”

Section: Commentarysupporting

confidence: 66%

Name as Many AEDs as you Can in One Minute: Antiepileptic Drugs and the Disruption of Verbal Fluency Networks

Chang¹

2018

Epilepsy Curr

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Section: Commentarysupporting

confidence: 66%

Name as Many AEDs as you Can in One Minute: Antiepileptic Drugs and the Disruption of Verbal Fluency Networks

Chang¹

2018

Epilepsy Curr

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“…The apparent drugdrug interactions may last for weeks after the last dose of CAI medication. In addition to the potential for reduced anesthetization during the IAP, these drugs also may affect neuropsychological and IAP memory scores (11,(23)(24)(25)29,30). Because the IAP is not without risk, everything should be done to ensure the most reliable results with the first test.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with discontinued TPM show a return of cognitive functions, demonstrating the reversibility of the effect (26). Interestingly, both TPM and ZNS reduced verbal performance in one study (29).…”

Section: Effects Of Cai Drugs On Cognitionmentioning

confidence: 86%

Reduced Anesthetization during the Intracarotid Amobarbital (Wada) Test in Patients Taking Carbonic Anhydrase–Inhibiting Medications

Bookheimer

Schrader²,

Rausch³

et al. 2005

Epilepsia

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Summary:Purpose: Failure to show adequate anesthetization during the intracarotid amobarbital procedure (IAP or "Wada test") is a rare complication. After an unusually high rate of recent anesthetization failures, we sought to determine the frequency of reduced anesthetization and any common factors underlying these failures.Methods: We reviewed the records of all patients who underwent IAP tests through the UCLA Seizure Disorder Center between September 1999 and May 2002. Age, date, epileptogenic focus, radiologist, and current medications were all considered.Results: Of a total of 56 patients who underwent our intracarotid amobarbital examination, 11 (19.6%) showed either very rapid recovery (≤1 min) or anesthetization failure. Of these, 10 (91%) of 11 were taking a medication with some carbonic anhydrase-inhibiting (CAI) properties (topiramate (TPM), n = 7; zonisamide (ZNS), n = 2; hydrochlorothiazide and furosemide, n = 1 each). The only patient of 40 (2.5%) who was not taking any CAI drugs and showed an early IAP recovery (55 s) had recently discontinued TPM. IAPs performed on patients after weaning from TPM showed a correlation between length of drug discontinuation and duration of anesthesia effect.Conclusions: Our data strongly suggest that recent failures of anesthetization during the IAP are associated with a possible interaction between amobarbital and medications possessing CAI properties. We suggest that the IAP be performed only after ≥8 weeks after discontinuation of such medications. Key Words: Topiramate-Carbonic anhydrase inhibitionIntracarotid amobarbital procedure (IAP)-Wada test.The intracarotid amobarbital procedure (IAP or Wada test) remains the gold standard for determining language laterality and predicting postoperative memory deficits in candidates for temporal lobectomy (1-5). A valid IAP requires that the patient demonstrate sufficient anesthetization in the injected hemisphere, marked by loss of contralateral muscle tone and strength, EEG slowing, and hemisphere-specific behavioral changes. Several complications may cause the occasional failure of an IAP. These include severe drowsiness, inattention, lack of patient cooperation due to disinhibition, infrequent perfusion patterns, and rarely, misplacement or slippage of the catheter out of the internal carotid artery (ICA) (4,6-8).

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“…Topiramate was followed distantly by ZNS with regard to the rate of IACEs. Some studies proposed that TPM and ZNS may cause cognitive impairment in similar manners because of their shared sulfa moiety or by increasing GABAergic activity in the prefrontal cortex [25,26]. Despite the similar mechanism of action, we found that TPM was associated with a much higher rate of IACEs compared to ZNS.…”

Section: Discussionmentioning

confidence: 53%

Cross-sensitivity of patient-perceived adverse cognitive effects with antiepileptic drug use

Chen

Detyniecki

Hirsch

et al. 2015

Epilepsy & Behavior

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Language Disturbances as Side Effects of Topiramate and Zonisamide Therapy

Cited by 67 publications

References 15 publications

Name as Many AEDs as you Can in One Minute: Antiepileptic Drugs and the Disruption of Verbal Fluency Networks

Name as Many AEDs as you Can in One Minute: Antiepileptic Drugs and the Disruption of Verbal Fluency Networks

Reduced Anesthetization during the Intracarotid Amobarbital (Wada) Test in Patients Taking Carbonic Anhydrase–Inhibiting Medications

Cross-sensitivity of patient-perceived adverse cognitive effects with antiepileptic drug use

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