Abstracts

Topiramate (TPM) use has been associated with variety of adverse effects on cognition. (1). However, studies comparing the tolerability of phenytoin (PHT), carbamazepine (CBZ) and TPM monotherapy are not available, rendering it difficult to judge which medication is superior in tolerability. We would like to report four patients who reported improved sense of well being on switching from PHT and CBZ to TPM..
Four patients were switched from PHT and CBZ to TPM. All were being treated for seizures. Patient 1 and 3 were loaded with PHT in the emergency room while patients 2 and 4 were gradually started on escalating doses. Formal neuropsychological testing was not done. The patient perception of well being was taken into account with open ended questions.
Patient 1: A 78 year old woman was on a PHT maintainance of 200 mg twice a day for five weeks then switched to CBZ secondary to side effects. After one week of therapy she decided to discontinue secondary to being tired and sleepy. She was subsequently switched to TPM at 100 mg twice a day. There were no further seizures with minimal word finding difficulties. Patient reported more energy and normalization of the excessive sleep.
Patient 2: A 43 year old woman was unable to tolerate CBZ 200 mg twice a day secondary to sexual dysfunction, headaches and lack of energy. She continued this medication for three months. On switching to TPM 75 mg twice a day she felt [quot]thrilled[quot] with improved headaches and escalated energy levels.
Patient 3: A 18 year old man developed photosensitive rash after two months of treatment with 300 mg of PHT a day. On switching to 100 mg twice a day of TPM, parents reported improved behavior and better performance at school.
Patient 4: A 47 year old woman was switched from 350 mg of PHT a day to TPM 150 mg BID secondary to the potential of long term side effects. She noted more energy, less fatigue and better tolerance with the TPM.
All four patients were seizure free and reported an improved sense of well-being. All four preferred to continue TPM secondary to better tolerance and minimal untoward side effects.
TPM is a useful addition to the spectrum of antiepileptic drugs. Although cognitive impairment is often quoted as a concerning side effect, some patients perceive improvement rather than impairment in their general sense of well being. Further studies are needed to define tolerability and patient[rsquo]s sense of well being as a whole utilizing a monotherapy approach.
REFERENCES:
Lee S, Sziklas V, Andermann F et al. The Effects od Adjunctive Topiramate on Cognitive Function in Patients with Epilepsy. Epilepsia 44 (3) : 339-347, 2003.