Topiramate-induced severe heatstroke in an adult patient: a case report

Canel, Lucie; Zisimopoulou, Sofia; Besson, Marie; Nendaz, Mathieu

doi:10.1186/s13256-016-0835-5

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…Despite the fact that this drug has almost ideal pharmacokinetic properties (the same as gabapentin and vigabatrin) as it is rapidly absorbed and excreted by urine and as there are no intermediate metabolites and fewer drug reactions in comparison with older anticonvulsants [5], still, several reports of side effects mention kidney stones, heatstroke [6], metabolic acidosis, respiratory alkalosis, increased metabolism of ethinylestradiol and progestogens, possibly a teratogenic effect, acute myopia and angle closure glaucoma, impaired concentration, dizziness, emotional lability, and psychosis [7,8]. Among the dermatological complaints are urticaria and angioedema as well as photosensitivity and pigmentary changes that return to normal after the discontinuation of the drug.…”

Section: Discussionmentioning

confidence: 99%

Acneiform Rash Caused by an Unlikely Drug: Topiramate

Bello‐Hernández¹,

Espinoza-Hernández

Moreno‐Coutiño³

2017

Skin Appendage Disord

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Topiramate is an antiepileptic drug that can also be used for migraine prophylaxis, weight control, and even for methamphetamine dependence; the dosage margin is wide, and the list of side effects is shorter than with other anticonvulsants. We present the case of a 35-year-old man with a disseminated rash of the trunk and extremities after treatment with 25 mg of topiramate daily as a prophylactic migraine treatment. This case report is useful, as this patient was not polymedicated and had a score of 7 on the Naranjo Adverse Drug Reaction Probability Scale. The patient was diagnosed as atypical DRESS syndrome and resolved satisfactorily with symptomatic treatment and topiramate withdrawal; slowly, the lesions regressed. He required no further drugs for the dermatologic condition.

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Section: Discussionmentioning

confidence: 99%

Acneiform Rash Caused by an Unlikely Drug: Topiramate

Bello‐Hernández¹,

Espinoza-Hernández

Moreno‐Coutiño³

2017

Skin Appendage Disord

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“…There is the possibility that CA II reduction is related to anhidrosis in AIGA patients because some evidence indicates that inhibition of CA II causes anhidrosis. Topiramate, an antiepileptic reagent, has been reported to cause hypohidrosis that was speculated to result from inhibitory effects on CA II 9,10,25,26 . In addition, some patients with topiramate‐induced hypohidrosis have associated general itching that often occurs in AIGA patients 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Topiramate, an antiepileptic reagent, has been reported to cause hypohidrosis that was speculated to result from inhibitory effects on CA II. 9,10,25,26 In addition, some patients with topiramate-induced hypohidrosis have associated general itching that often occurs in AIGA patients. 10 AIGA is considered to have an autoimmune pathology, and autoantibodies against CA II are a possible cause of AIGA.…”

Section: Discussionmentioning

confidence: 99%

Clear cell injury associated with reduced expression of carbonic anhydrase II in eccrine glands consistently occurs in patients with acquired idiopathic generalized anhidrosis

Sakai

Asahina

Uehara

et al. 2021

The Journal of Dermatology

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Acquired idiopathic generalized anhidrosis (AIGA) is characterized by anhidrosis/hypohidrosis without other autonomic and neurological dysfunctions. It has been believed that AIGA patients usually present no significant morphological alterations in the secretory portion of eccrine glands consisting of clear, dark and myoepithelial cells. However, we have recently revealed morphological damage of eccrine glands in AIGA patients by immunohistochemistry. Moreover, inhibitory side‐effects against carbonic anhydrase II (CA II) by the antiepileptic reagent topiramate have been reported to cause heat intolerance mimicking AIGA. To determine the precise morphological changes and CA II expression in eccrine glands of AIGA patients, electron microscopic observation and immunohistochemistry were applied to skin of both anhidrotic (non‐sweating) and normohidrotic (sweating‐preserved) sites, taken from each patient clinically diagnosed with AIGA. We found consistent clear cell injury in eccrine glands in anhidrotic skin samples of AIGA patients. Electron micrographs demonstrated edematous, swollen and destructive damage in clear cells of eccrine glands from non‐sweating areas of almost all AIGA patients. Immunohistochemically, clear cells showed reduced CA II expression that was heterogeneously distributed in non‐sweating skin. Some areas showed almost complete loss of CA II expression in spite of preserved dark cells, and others showed mild or moderate loss of it. Selective destruction of clear cells resulting in heterogenous atrophy in AIGA patients may be important to elucidate its etiology.

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“…Anti-epileptic drugs, also used on- and off-label for migraine and mood disorders, have no known impact on COVID-19 risks, but there are some cautions in migraineurs developing acute COVID while taking them. Carbonic anhydrase inhibitors such as topiramate may trigger acute kidney injury or rhabdomyolysis in dehydrated patients [ 45 ]. There are no data that valproate worsens COVID-19 outcomes, but it must be avoided if pregnancy is possible.…”

Section: Preventive Treatment (Migraine Prophylaxis)-(table 2 )mentioning

confidence: 99%

Navigating migraine care through the COVID-19 pandemic: an update

Angus‐Leppan

Guiloff

Benson³

et al. 2021

J Neurol

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The worldwide treatment gap for migraine before COVID-19 inevitably widens as attention focuses on an international emergency. Migraine hits people particularly in their early and middle years, potentially reduces quality of life and productivity, and remains a common emergency presentation. This article examines the impact of COVID-19 on migraine, and changing aspects of migraine care during and after the pandemic. Many risk factors for severe COVID-19-older age, male gender, cardiac and respiratory diseases, diabetes, obesity, and immunosuppression-are less frequent in migraineurs. Telemedicine is effective for migraine follow-up, and needs ongoing evaluation. Most migraine treatments can start or continue in acute COVID-19, with care to avoid drug interactions. Close contact procedures (botulinum toxin, acupuncture and steroid injections) are avoided in lockdown or in the vulnerable. Secondary effects of COVID-19, including long COVID and its economic impact, are probably equal or greater in people with migraine. Migraine and other long-term conditions need adequate resourcing to prevent personal, social and economic suffering. Treating migraine, a sequel of COVID, potentially reduces the impact of long COVID.

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Topiramate-induced severe heatstroke in an adult patient: a case report

Cited by 12 publications

References 13 publications

Acneiform Rash Caused by an Unlikely Drug: Topiramate

Acneiform Rash Caused by an Unlikely Drug: Topiramate

Clear cell injury associated with reduced expression of carbonic anhydrase II in eccrine glands consistently occurs in patients with acquired idiopathic generalized anhidrosis

Navigating migraine care through the COVID-19 pandemic: an update

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