Topiramate: Effects on cognition in patients with epilepsy, migraine headache and obesity

Abstract

This paper reviews the clinical implications of topiramate (TPM)-induced cognitive deficits in patients with epilepsy, migraine headache, obesity, and in normal populations, followed by reviews of the literature describing the reversal of such deficits upon medication discontinuation. It also discusses animal investigations of TPM's role of neuroprotection in brain injury. TPM's most intolerable adverse effects (AEs) are on verbal fluency and reaction time, resulting in high discontinuation rates in patients taking it for epilepsy and migraine headache. However, because TPM is so effective in the treatment of epilepsy and migraine headache, its use is expected to continue. There appears to be greater tolerance of TPM's cognitive AEs when it is used in the treatment of obesity, perhaps because of the lower doses required. Research attempting to predict the populations most vulnerable to the cognitive effects caused by TPM is ongoing. Studies suggest that one such population may include patients with a past psychiatric history. Slow titration and administration of the lowest possible doses may decrease risk of cognitive deficits.

Assessment of everyday executive functioning in children with frontal or temporal epilepsies

“…In addition, it remains to determine the impact of the type of AEDs, and not only their number, on the cognitive functioning of these children, in particular the executive functioning. For example, topiramate induces an increase in reaction time and difficulties in verbal fluencies and working memory tasks [52][53][54].…”

Topiramate has protective effect on renal injury

“…Apoptosis plays also a major role in kidney injury induced by I/R. Topiramate (TPM), which is a sulfamate-substituted monosaccharide, is used in neurotherapy for the management of epilepsy and migraine (9). It is documented to possess weight-reducing properties in addition to insulin resistance-improving effects (10,11).…”

Bariatric Surgery in Youth

“…Although an average decrease in BMI of 5% was seen in a recent retrospective study evaluating the use of this agent in adolescents, the associated cognitive side effects, including mental slowing, may preclude its use. 51,52 Additional studies are needed to further evaluate the effectiveness and safety of medications used to promote weight loss in obese youth.…”