Topiramate-Induced Palinopsia

Abstract

Topiramate-induced palinopsia may be underdiagnosed because physicians do not inquire about such visual symptoms.

Palinopsia Following Acute Unilateral Partial Vestibular Deafferentation: A Case Report

“…Palinopsia is usually accompanied by a visual field defect but some cases with a normal visual field have been observed such as that described by Praveen-Kumar and Rajesh ( 10 ), a patient affected by a temporo-occipital anaplastic oligodendrioglioma, or those of Ritsema et al ( 11 ), one with an arteriovenous malformation in the lingual gyrus of the left occipital lobe and one with an ischemic stroke in the left peri-atrial region, near to the left optic radiations. In addition, multiple illicit drugs (marijuana, mescaline, lysergic acid dyethilamide, 3,4-methylenedioxymethamphetamine), and prescription drugs (interleukin 2, topiramate, trazodone, clomiphene citrate, nefazodone) can elicit episodes of palinopsia ( 12 – 14 ). Other known causes include poisoning with carbon monoxide or different other gazes, psychiatric conditions (Charles-Bonnet syndrome, schizophrenia, psychotic depression), metabolic and systemic diseases (non-ketotic hyperglycemia, diffuse cortical pathology), migraine, or diseases limited to the retina or optic nerve ( 3 , 5 ).…”

“…The pathophysiology of palinopsia is not clear, but many hypothesis are proposed. One of them is that drugs could alter serotoninergic activity ( 12 – 14 ) or inhibit the synthesis of gamma-aminobutyric acid involved in the generation of action potentials of the visual system ( 16 , 17 ). Another involves a local irritation of the occipito-parietal cortex by surrounding oedema ( 18 ).…”

Palinopsia After Splenium Infarction

“…Palinopsia is defined as the persistence or recurrence of a previous visual image (1). Palinopsia could be related to systemic disorders, migraine, central nervous system diseases, and various medications such as topiramate, marijuana, or lysergic acid diethylamide (2). Brain lesions, especially the visual cortex area, can cause palinopsia (3).…”

Cinema-like sensory phenomena in a migraine patient on topiramate

“…Visual phenomena observed by him resembled pallinopsia which is a distortion of visual processing with images persisting or recurring after removal of visual stimulus. [ 3 ] However, they were accompanied by auditory phenomena, giving rise to a feeling of an audiovisual of cinema or video recording being run at fast mode. Due to these sensory phenomena, topiramate was stopped and 10 mg of flunarizine daily was prescribed.…”

“…[ 1 ] However, sensory phenomena described here occur at lower doses. [ 1 3 ] Change in serotonergic activity can cause palinopsia and combining amitriptyline with topiramate may have lead to this phenomena or it is possible that cumulative doses of topiramate after daily administration may have been the possible etiology. [ 4 ] Topiramate levels were, however, not obtained.…”