Topiramate reduces nocturnal eating in sleep-related eating disorder

Abstract

Study Objectives Sleep-related eating disorder (SRED) is a parasomnia characterized by partial arousals from sleep with compulsive consumption of food with impaired level of awareness and memory for the event. Small case series’ have demonstrated efficacy of topiramate in SRED. We conducted a placebo-controlled randomized clinical trial of topiramate to assess efficacy in SRED. Methods Thirty-four participants with an ICSD-2/ICSD-3 diagnosis of SRED with >6 months of symptoms and ≥3 sleep-related eating episodes per week were randomized to placebo or topiramate with flexible dosing to a maximum dosage of 300 mg for 13 weeks. Primary outcomes were percentage of nights with eating and Clinician Global Impression-Improvement (CGI-I). Intention-to-treat last observation carried forward (ITT LOCF) analysis was conducted. Results Mean age was 39.5 years, 74% were female, with mean duration of sleep-related eating of 13.7 years. SRED symptoms were significantly reduced with topiramate (74.7% to 33.2% nights/week; n = 15) compared to placebo (77.0% to 57.4%; n = 17) (p = 0.035). There were significantly more CGI-I responders on topiramate (71%) than placebo (27%) (p = 0.016). Level of wakefulness (r = −0.49) and memory for nighttime eating (r = −0.58) at baseline predicted topiramate response. The topiramate group lost significantly more weight than the placebo group (−8.5 lbs vs. +1.0 lbs, p = 0.001). The most common side effects were paresthesias and cognitive dysfunction. Conclusions This first randomized controlled trial demonstrating efficacy for treatment of SRED supports preliminary data on the use of topiramate for SRED. Side effects were prominent for topiramate. Limitations include a small sample size and a high drop-out rate in both study groups. Clinical Trial Information NCT00606411

Sleepwalking, sleep-related eating disorder and sleep-related smoking successfully treated with topiramate: a case report

“…Treatment with topiramate was initiated in this case, given its documented benefit for controlling SRED in several reports 8 . Most notably, in a randomized control trial, SRED symptoms were significantly reduced with topiramate (74.7% to 33.2% nights/week; n=15) compared to placebo (77.0% to 57.4%; n=17) 9 .…”

Sleep-related eating disorder associated with zolpidem: cases compiled from a literature review

“…A new option may include selective serotonin reuptake inhibitors (SSRI), which have been beneficial in patients presenting with idiopathic SRED and depression [ 39 ]. Recently, a randomized, controlled study with topiramate for idiopathic SRED demonstrated a reduction of SRED symptoms; however, this study excluded participants on medications thought to contribute to the presence of SRED [ 40 ]. While there are several pharmacological options to treat SRED, treating underlying disorders and discontinuing precipitating drugs, like zolpidem, should be considered first.…”

NREM and REM sleep parasomnias: clinical cases and literature review

“…Ac cord ing to the large co hort study, clonazepam ef fi cacy is 72.2%, while ef fective ness of zolpidem, fluoxetine, citalopram, mirtazapine, melatonin range be tween 58-78% [7]. Dif fer ent ap proach is ap pli ca ble for sleep-re lated eat ing dis or der since topiramate and sertraline were found to be ef fi ca cious in re duc ing night-time eat ing in pa tients with SRED [28]. More over, con vinc ing ev i dence proves that cir ca dian sleep-wake rhythm dis or ders could be cured with melatonin [11].…”