Abstracts

RATIONALE:Presentig a previously unreported complication of Topiramate Therapy. METHODS:Case report of clinical and EEG data in a seizure patient presenting with Topiramate induced non-convulsive status and review of medical literature . RESULTS: We present a case history of a 44 year old man who was HIV positive secondary to Facor VIII deficiency and had intractable post-traumatic epilepsy.He was admitted to the hospital with new onset of confusion and decreased level of consciousness for two days.One month prior he had been started on Topiramate as an add on therapy to Valproate and Phenobarbital, and dose of Topiramate was gradually escalated to 50 mg bid which he was taking for 3 days prior to admission.He was also taking Lamivudine(potease inhibitor),Trimethoprim-sulfamethoxazole and Folte.There were no recent changes in the dosages and blood levels of Valproate(84)and Phenobarbital(25).His Head CT scan and other laboratory data did not show any significant change.EEG showed diffuse spikes, polyspikes and slow wave coplexes almost every 5 to 10 seconds consistent with non-convulsive status. Topiramate was stopped immediately and over the next three days his mental status improved dramatically with almost complete disappearance of epileptiform discharges on repeat EEG. CONCLUSIONS:Topiramate, a new anti-epileptic drug, can induce non-convulsive status and patient should be carefully watched for any changes in mental status and/or EEG , especially if they are on protease inhibitor.