Open-label comparative study of the efficacy of sodium valproate and topiramate as prophylactic therapy for migraine in adults

Background: Migraine is a most common and highly prevalent neurologic disorder characterized by recurrent moderate-to-severe headaches often in association with a number of autonomic nervous system symptoms. Sodium valproate and topiramate are the two newer antiepileptic agents which are commonly prescribed for the migraine prophylaxis in India. Aims and Objectives: The aims of the study were as follows: (1) To compare the efficacy of sodium valproate 15–30 mg/kg/day and topiramate 2–3 mg/kg/day as prophylactic therapy for migraine in adults and (2) to study cost-effectiveness and safety profile of sodium valproate and topiramate. Materials and Methods: It is an open-label comparative study; 100 migraine patients of age group between 20 years and 50 years of both sexes were enrolled in the present study according to the inclusion criteria. Patients were diagnosed as migraine as per the International Criteria For Headache Disorders-3. Before starting treatment and after diagnosis, investigations have done, that is, complete blood picture, liver function test, renal function test, random blood sugar, and thyroid profile. Randomization was done by choosing every alternate patient and study drugs were prescribed. One hundred patients were divided into two groups, Group-A: 50 patients administered Tab. sodium valproate 500 mg twice daily orally and Group-B: 50 patients administered Tab. topiramate 150 mg once daily orally for a period of 6 months. Results: In Group-A, the severity of pain value before starting treatment was 6.440 ± 2.130 which is reduced to 1.820 ± 1.024 at the end of the treatment which was statistically significant (P < 0.0001) and the frequency of headache value before starting treatment was 4.220 ± 1.298 which is reduced to 1.320 ± 0.7407 at the end of the treatment, P < 0.0001 which was statistically significant. In Group-B, the severity of pain value before starting treatment was 6.200 ± 2.119 which is reduced to 1.840 ± 0.9765 after starting treatment which was statistically significant (P < 0.0001) and the frequency of headache value before starting treatment was 4.300 ± 1.199 which is reduced to 1.340 ± 0.6884 after starting treatment, P < 0.0001 which was statistically significant. In between the two groups severity of migraine pain and headache frequencies the P value was statistically significant. Conclusion: The results of the present study demonstrated that both sodium valproate and topiramate were well tolerated, having similar efficacy in reducing the severity of the pain, headache frequencies, and improving the quality of life. Sodium valproate is preferred because of cost-effectiveness.

Effects of topiramate, bupropion and naltrexone isolated or combined on subcutaneous adipose tissue in obese rats

ABSTRACT Objective: To evaluate the effects of combining topiramate, bupropion and naltrexone in obesity-induced rats on their weight and subcutaneous adipose tissue. Methods: A total of 40 male Wistar rats were induced to obesity for 8 weeks and the animals were divided into 8 groups: Ctr - control, G0 - Sham, G1 - oral saline solution (1.0mL/day), G2 - topiramate (20.0mg/kg) and bupropion (5.0mg/kg), G3 - naltrexone (20.0mg/kg), G4 - topiramate (20.0mg/kg), G5 - bupropion (5.0mg/kg) and G6 - topiramate (20.0mg/kg), bupropion (5.0mg/kg) and naltrexone (20.0mg/kg). During the experiment, all animals were weighed weekly. After 30 days of treatment animals were euthanized and their skin fragments were processed and stained with hematoxylin and eosin for morphological, morphometric and biochemical analyzes. Results: The only group that presented a decrease in the volume of subcutaneous adipose tissue was G3, but this decrease was not significant when compared with the other groups. The G4, the G5 and the G6 presented increased adipose tissue volume. Data showed that until the eighth week all animals increased their weight by approximately 50%. After treatment animals of all groups, except G3, increased their weight from 4% to 9% approximately. The G3 was the only group that lost weight, but this decrease was not significant. Conclusion: The medicines studied were not efficient in reducing weight in obese rats. However, it should be considered that 30-day treatment period is not enough to observe the stronger effects of these drugs.

Effects of levetiracetam combined with low-dose topiramate on bone and lipid metabolism in children with epilepsy / 中国基层医药

Objective:To investigate the efficacy of levetiracetam combined with low-dose topiramate on epilepsy and its effects on bone metabolism and lipid metabolism in children.Methods:A total of 108 children with epilepsy who received treatment in the First People's Hospital of Yongkang from August 2016 to December 2019 were included in this study. They were randomly allocated to study and control groups ( n = 54/group). The study group was treated with levetiracetam combined with low-dose topiramate. The control group was treated with carbamazepine combined with low-dose topiramate. Before treatment and half a year after treatment, serum alkaline phosphatase (ALP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels, blood Ca 2+ and P 3- concentrations, and bone mineral density (BMD) were determined. Clinical efficacy was evaluated in each group. Results:Half a year after treatment, blood Ca 2+ concentration, blood P 3- concentration, and BMD in the study group were (2.41 ± 0.35) mmol/L, (1.57 ± 0.26) mmol/L, and (2.21 ± 0.52) g/cm2, respectively, which were significantly greater than those in the control group [(2.19 ± 0.27) mmol/L, (1.18 ± 0.15) mmol/L, (1.81 ± 0.38) g/cm, tca2+ = 4.20, tbloodP3- = 5.73, tBMD = 6.42, all P < 0.05). ALP level was significantly lower in the study group than in the control group [(129.78 ± 25.63) U/L vs. (181.55 ± 21.94) U/L, t = 15.39, P < 0.05). Half a year after treatment, TC, TG, and LDL-C levels in the study group were (4.38 ± 0.64) mmol/L, (1.71 ± 0.42) mmol/L, and (1.65 ± 0.32) mmol/L, respectively, which were significantly lower than those in the control group [(4.76 ± 0.83) mmol/L, (1.96 ± 0.45) mmol/L, (1.98 ± 0.34) mmol/L, tTC = 3.81, tTG = 4.14, tLDL-C = 5.58, all P < 0.05]. HDL-C level in the study group was significantly higher than that in the control group [(1.96 ± 0.38) mmol/L vs. (1.63 ± 0.27) mmol/L, tHDL-C = 7.39, P < 0.05]. Half a year after medication, clinical efficacy was significantly higher in the study group than that in the control group (94.44% vs. 81.48%, χ2 = 6.29, P < 0.05). Conclusion:Low-dose topiramate combined with levetiracetam is highly effective on epilepsy in children. The combined therapy has less impact on the levels of bone and lipid metabolism indicators and is suitable for clinical application.

Eficácia do topiramato como terapia adicional em pacientes com estado epiléptico refratário: uma breve revisão sistemática / Efficacy of topiramate as an add-on therapy in patients with refractory status epilepticus: a short systematic review

RESUMO Objetivo: Identificar evidências atuais sobre topiramato para o estado de mal epiléptico refratário. Métodos: Foi revisada a literatura para investigar a eficácia do topiramato no tratamento de estado de mal epiléptico refratário. Os termos de busca utilizados foram: "status epilepticus", "refractory", "treatment" e "topiramate". Não se empregaram restrições. Resultados: A busca identificou 487 artigos que descreviam o uso de topiramato para tratamento de estado de mal epiléptico refratário e seus resultados. Relatos de caso, revisões e experimentos em animais foram excluídos. Após exclusão de duplicatas e aplicação dos critérios de inclusão e exclusão, restaram nove estudos. Realizaram-se análises descritivas e qualitativas, com os seguintes resultados: as taxas de resposta, definidas como término de crises até 72 horas após administração de topiramato, variaram entre 27% e 100%. A mortalidade variou de 5,9% a 68%. Desfechos funcionais positivos, definidos como alta hospitalar, volta à funcionalidade basal ou reabilitação, foram documentados por sete estudos, e as taxas variaram entre 4% e 55%. A maioria dos estudos reportou apenas efeitos colaterais leves ou ausentes. Conclusão: Topiramato foi efetivo em abortar estado de mal epiléptico refratário, apresentando baixa mortalidade e boa tolerabilidade. Portanto, topiramato poderia ser uma boa opção como terceira linha para estado de mal epiléptico refratário, porém mais estudos são necessários.

ABSTRACT Objective: To identify current evidence on the use of topiramate for refractory status epilepticus. Methods: We reviewed the literature to investigate the efficacy of topiramate in the treatment of refractory status epilepticus. The search terms used were "status epilepticus", "refractory", "treatment" and "topiramate". No restrictions were used. Results: The search yielded 487 articles that reported using topiramate as a treatment for refractory status epilepticus and its outcomes. Case reports, review articles, and animal experiments were excluded. After excluding duplicates and applying inclusion and exclusion criteria, nine studies were included for analyses. Descriptive and qualitative analyses were performed, and the results were as follows: response rates (defined as termination in-hospital until 72 hours after the administration of topiramate) varied from 27% to 100%. The mortality rate varied from 5.9% to 68%. Positive functional long-term outcomes, defined as discharge, back to baseline or rehabilitation, were documented by seven studies, and the rates ranged between 4% and 55%. Most studies reported no or mild adverse effects. Conclusion: Topiramate was effective in terminating refractory status epilepticus, presented relatively low mortality and was well tolerated. Therefore, topiramate could be a good option as a third-line therapy for refractory status epilepticus, but further studies are necessary.

A sensitive analytical liquid chromatography-tandem mass spectrometry method for the estimation of Topiramate in bulk and pharmaceutical formulation

Topiramate is an anticonvulsant used to treat seizures and prevent migraines. The aim of this study was to develop andvalidate a simple and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to quantifyTopiramate in its formulation. Acetonitrile and ammonium acetate were used as a mobile phase (85:15 v/v ratio),and isocratic elution mode was used for separation using Zorbax RP-C18Column (50 mm × 4.6 mm i.d., 5 µ) asa stationary phase. The standard calibration curve ranges from 1 to 1,000 ng/ml with a correlation coefficient of0.9990 (R2). The detection and quantification limits were obtained at 0.5 and 1.0 ng/ml, respectively. The total runtimeof chromatographic separation was found to be 2.0 minutes with a retention time of 1.23 minutes. The percentagerecovery studies were found to be 90.3%–99.3%. The developed method was found to be simple and sensitive and canbe used for the estimation of Topiramate in bulk and its pharmaceutical formulations.

Observation of Adverse Effect of Topiramate & Propranolol in Migraine Prophylaxis

Background: Migraine headache is a common neurologicalepisodic condition originating from the central nervous systemthat can significantly impair the lives of otherwise normallyfunctioning people. Pharmacologic options for migraineprophylaxis include beta blockers, calcium channel blockers,antidepressants and anticonvulsants; all of which have varyingdegrees of adverse effects that may significantly limit their usein this disease.Objectives: To observe whether low dose Topiramate is moreeffective compared to Propranolol in migraine prophylaxis.Methods: This clinical trial was carried out in the Out PatientDepartment (OPD) & Headache Clinic, Department ofNeurology, Bangabandhu Sheikh Mujib Medical University,Dhaka. A total of 120 patients around the age range of 18 to 50years diagnosed as migraine (with aura or without aura)according to ICHD-3 criteria, were recruited as the studypopulation. By simple random sampling procedure, using odd& even number, 60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest 60 patientswere administered by Tab. Propranolol 80 mg /day named asgroup-II. Out of them in total 96 patients had completed thestudy due to drop out of 13 patients in group-I & 11 patients ingroup-II in different steps of follow up. Finally 47 patientsremain in group-I and 49 patients in group-II. During trial, threefollow up visits were taken for both group, 1st follow up after 4weeks of baseline information (Before starting prophylacticmedication), 2nd follow up after 4 weeks of treatment, 3rdfollow up after 8 weeks of treatment. Efficacy of treatment wasmeasured by headache frequency, duration and Severity ofheadache as measured by the VAS.Results: The mean (SD) age of group-I (topiramate) andgroup-II (propranolol) group were found 29.72 (9.58) yearsand 30.96 (10.11) years respectively. Female sex was foundpredominant in both groups. At final follow up, there wasstatistically significant difference in mean (SD) value offrequency of migraine attack between topiramate andpropranolol group [4.72 (2.80) vs. 3.48 (2.20); p=0.024].Propranolol appeared statistically significant than topiramate[TPM 5.53 (2.98) vs. PRO 4.36 (1.55); p=0.047]. RegardingSeverity of headache, better results also were observed in thepropranolol group than topiramate (p < 0.05). Both drugsappeared significant in efficacy measurement (p < 0.001).Patient drop out was more in the topiramate group than thepropranolol group (21.68 % vs. 18.34%). Furthermore, in thetopiramate group, patients complained of more adverse effectsthan propranolol group (23.4% vs. 14.3%), which wasstatistically significant.Conclusion: The present study suggests that low doseTopiramate and Propranolol are effective for migraineprophylaxis in reduction of frequency, Severity and duration ofmigraine headache individually and propranolol appears moreeffective compared to that of topiramate.

Preventive effects of Topiramate on methylphenidate induced behavioral disorders / Efectos preventivos de topiramato en los trastornos del comportamiento inducidos por metilfenidato

Neuronal cell damage is often caused by prolonged misuse of Methylphenidate (MPH). Topiramate (TPM) carries neuroprotective properties but its assumed mechanism remains unclear. The present study evaluates in vivo role of various doses of TPM and its mechanism against MPH-induced motor activity and related behavior disorder. Thus, we used domoic acid (DOM), bicuculline (BIC), Ketamine (KET), Yohimibine (YOH) and Haloperidole (HAL) as AMPA/kainite, GABAA, NMDA, ɑ2 adrenergic and D2 of dopamine receptor antagonists respectively. Open Field Test (OFT), Elevated Plus Maze (EPM) and Forced Swim Test (FST) were used to study motor activity, anxiety and depression level. TPM (100 and 120 mg/kg) reduced MPH-induced rise and inhibited MPH-induced promotion in motor activity disturbance, anxiety and depression. Pretreatment of animals with KET, HAL, YOH and BIC inhibited TPM- improves anxiety and depression through the interacting with Dopaminergic, GABAA, NMDA and ɑ2-adrenergic receptors.

El daño a las células neuronales a menudo es causado por el uso prolongado de metilfenidato (MPH). El topiramato (TPM) tiene propiedades neuroprotectoras, pero su mecanismo de acción no es claro. El presente estudio evalúa el papel in vivo de varias dosis de TPM y su mecanismo contra la actividad motora inducida por MPH y el trastorno de comportamiento relacionado. Utilizamos ácido domoico (DOM), bicuculina (BIC), ketamina (KET), yohimbina (YOH) y haloperidol (HAL), así como antagonistas AMPA/kainato, GABAA, NMDA, ɑ2-adrenérgico y D2 dopaminérgicos, respectivamente. Se utilizaron las pruebas de campo abierto (OFT), elevación de laberinto (EPM) y natación forzada (FST) para estudiar la actividad motora, la ansiedad y el nivel de depresión. El TPM (100 y 120 mg/kg) redujo el aumento inducido por MPH e inhibió la promoción inducida por MPH en la alteración de la actividad motora, la ansiedad y la depresión. El tratamiento previo de animales con KET, HAL, YOH y BIC inhibió el TPM, mejora la ansiedad y la depresión a través de la interacción con los receptores dopaminérgicos, GABAA, NMDA y ɑ2-adrenérgico.

Glaucoma y miopía agudos inducidos por el uso de topiramato / Acute glaucoma and myopia induced by the use of topiramate

El topiramato es una droga utilizada en varias enfermedades, como las neurológicas y las psiquiátricas. Entre sus efectos adversos se encuentra la producción de miopía aguda y glaucoma por cierre angular secundario en ojos previamente sanos. A pesar de que se trata de efectos adversos relativamente infrecuentes, los mismos deben tomarse en consideración puesto que su expresión clínica (cefalea y dolor periocular, entre otros) puede ser muchas veces confundida con la patología de base para la cual se estaba utilizando el topiramato (por ejemplo, para el tratamiento de la migraña). Lo anterior es importante puesto que dichos efectos adversos solo cesarán con la interrupción del uso de la droga. En este breve artículo de revisión se presentan conceptos básicos acerca de la fisiopatología y del tratamiento de la miopía y del glaucoma por cierre angular inducidos por el uso de topiramato.

Topiramate is a drug used in several diseases, such as neurological and psychiatric ones. Among its adverse effects are the production of acute myopia and glaucoma by secondary angular closure in previously healthy eyes. Although these are relatively infrequent adverse effects, they must be taken into consideration since their clinical expression (headache and periocular pain, among others) can often be confused with the pathology for which topiramate was being used (for example, for the treatment of migraine). The foregoing is important since such adverse effects will only cease with the interruption of the use of the drug. In this brief review article, we present basic concepts about the physiopathology and treatment of myopia and glaucoma by angular closure induced by the use of topiramate.

Adverse effects of topiramate in patients with epilepsy in a tertiary care hospital: observational study

Background: Epilepsy is a common chronic neurological disorder characterized by paroxysmal cerebral dysrhythmia. Conventional antiepileptic drugs such as Phenytoin, carbamazepine, phenobarbitone and sodium valproate, have been proven to have good therapeutic effects. There are currently more than 10 different adjuvants which are approved for use in epileptics. Topiramate, a second-generation antiepileptic drug, is being used for several types of partial-onset and generalized-onset seizures. Effective treatment of epilepsy depends on medication compliance. The incidence of adverse effects is an important issue when antiepileptic drugs are prescribed to treat epilepsy. This study was done in Department of Neurology to observe the adverse effects of Topiramate in patients with epilepsy in a Tertiary care hospital.Methods: For this study 100 patients receiving topiramate as an adjuvant drug along with regular anti epileptic drugs were enrolled in the study for prescheduled three months. Data of the patients were collected.Results: In this study we observed that paresthesia (31%) was the commonly noted adverse effect followed by cognitive impairment (24%), sleepiness (19%), nausea (13%), anorexia (9%) and weight loss (4%).Conclusions: Topiramate is a potent antiepileptic drug effective against most seizure types and has relatively favourable pharmacokinetic profile. It is appropriate for initial monotherapy as well as for adjuvant therapy in refractory patients. The major problem limiting its use is the frequent occurrence of cognitive adverse effects, especially expressive language dysfunction, which are reversible upon discontinuation of the medication.

Clinical effect of levetiracetam combined with topiramate in the treatment of refractory epilepsy syndrome / 中国基层医药

Objective@#To observe the clinical effect of levetiracetam combined with topiramate in the treatment of children with Lennox-Gastaut syndrome(LGS).@*Methods@#From January 2016 to August 2018, 60 cases of LGS syndrome admitted to the pediatrics department of Ganzhou People's Hospital were selected The patients were divided into left ethylancetan single drug treatment group, topiramate single drug treatment group, and left ethylancetin combined with topiramate treatment group according to the digital table, with 20 cases in each group.The children in the three groups were treated with the intervention of levetiracetam, topiramate and levetiracetam combined with topiramate according to the test requirements.After 8 weeks of treatment, the clinical efficacy was compared among the three groups in terms of efficacy, cranial magnetic resonance spectrum, eeg slow wave index and intelligence evaluation.@*Results@#The clinical effective rate(95%), NAA/Cho+ Cr(0.882±0.107), NAA/Cho(1.624±0.088) and NAA/Cr(1.634±0.042) of the combined treatment group were significantly higher than those before treatment, the differences were statistically significant(all P<0.05). The eeg slow wave index[(9.11±0.63)μV]and sleep period[(18.02±0.66)μV] were significantly lower than those before treatment, and the differences were statistically significant(all P<0.05). The comprehension scores[(15.62±2.55)points], FIQ scores[(106.85±2.64)points]and VIQ scores[(107.28±3.06)points]were significantly higher than those before treatment, the differences were statistically significant(all P<0.05).@*Conclusion@#Levetiracetam combined with topiramate in the treatment of refractory epilepsy syndrome has good curative effect, and is worthy of wide clinical application.

Clinical effect of levetiracetam combined with topiramate in the treatment of refractory epilepsy syndrome / 中国基层医药

Objective To observe the clinical effect of levetiracetam combined with topiramate in the treatment of children with Lennox －Gastaut syndrome ( LGS).Methods From January 2016 to August 2018, 60 cases of LGS syndrome admitted to the pediatrics department of Ganzhou People ＇s Hospital were selected The patients were divided into left ethylancetan single drug treatment group ,topiramate single drug treatment group ,and left ethylancetin combined with topiramate treatment group according to the digital table ,with 20 cases in each group. The children in the three groups were treated with the intervention of levetiracetam , topiramate and levetiracetam combined with topiramate according to the test requirements.After 8 weeks of treatment , the clinical efficacy was compared among the three groups in terms of efficacy ,cranial magnetic resonance spectrum ,eeg slow wave index and intelligence evaluation.Results The clinical effective rate (95%), NAA／Cho +Cr (0.882 ±0.107 ), NAA／Cho (1.624 ±0.088) and NAA／Cr(1.634 ±0.042) of the combined treatment group were significantly higher than those before treatment,the differences were statistically significant(all P＜0.05).The eeg slow wave index[(9.11 ±0.63)μV] and sleep period[(18.02 ±0.66)μV] were significantly lower than those before treatment ,and the differences were statistically significant(all P＜0.05).The comprehension scores [(15.62 ±2.55) points],FIQ scores[(106.85 ± 2.64)points] and VIQ scores [(107.28 ±3.06) points] were significantly higher than those before treatment , the differences were statistically significant (all P＜0.05).Conclusion Levetiracetam combined with topiramate in the treatment of refractory epilepsy syndrome has good curative effect ,and is worthy of wide clinical application.

Comparative Efficacy Of Baclofen And Topiramate In Alcohol Dependence Syndrome: A 3 Months Follow Up Study

Objective: Craving plays significant role in relapse in patients with alcohol dependence syndrome. Baclofen and topirmate are effective in reduction of craving and maintenance of abstinence in various placebo controlled trials. Method:It is a retrospective study of patients of alcohol dependence who were admitted in de-addiction ward from January- December 2013. Case record files of patient who completed detoxification and were prescribed either baclofen or topiramate were taken out and analyzed after applying coding plan. Results: A total of 68 patients fulfilled the inclusion criteria, 40 in baclofen group and 28 in topiramte group. Mean age was 38 years in baclofen group and 41 years in topiramate group. Majority of the patients in both the groups were married and employed. Majority of the patients in both the groups had duration of alcohol dependence between 5-10 years. 32.5 % patients in baclofen group did not report craving at 3 months against 14.2% in topiramte group and 47.5% patients in baclofen group remained abstinent at 3 months against 28.5% in topiramate group. Conclusion: Both baclofen and topiramate are effective in reduction of craving and maintaining abstinence in patients with alcohol dependence syndrome and baclofen fared better than topiramate.

Topiramate-induced acute angle closure with severe panuveitis: A challenging case report

A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.

Uso del topiramato en pacientes con síndrome de dolor lumbar crónico con síntomas ansiosos y depresivos secundarios a sensibilización central con y sin compromiso neuropático resistente a tratamiento convencional / Use of topiramato in patients with chronic lumbar pain syndrome with ansiosius symptoms and secondary depression to central sensitization with and without neuro-pathic commitment resistant to conventional treatment

INTRODUCCIÓN: El dolor lumbar crónico genera alta disfuncionalidad, su tratamiento es complejo y en algunos casos se presenta refractariedad a tratamientos convencionales. El síndrome de sensibilización central por dolor lumbar involucra presencia de síntomas ansiosos, depresivos, trastorno del sueño, fatiga, alteraciones del apetito y disfuncionalidad en actividades de la vida diaria. El manejo del dolor lumbar crónico con síndrome de sensibilización central es dificultoso, requiere de intervenciones multidimensionales y esquemas farmacológicos atípicos. OBJETIVO: Se describe el uso de topiramato como fármaco coadyuvante en el manejo de pacientes con dolor lumbar crónico resistente a tratamiento standard en 25 pacientes. MATERIALES Y MÉTODO: Seguimiento a 12 semanas y evaluación de funcionalidad, sintomatología ansiosa-depresiva, control del dolor y fatiga a través de múltiples escalas. Resultados: La dosis mediana fue de 300mg. El 72 por ciento (18 pacientes) presenta mejoría estadística en síntomas angustiosos, depresivos, sueño, EVA de dolor y fatiga y funcionalidad. Solo el 16 por ciento (4 pac) presentan reacciones adversas que obligan a suspensión del fármaco. El 12 por ciento (3 pacientes) no presentaron respuesta terapéutica. DISCUSIÓN: El topiramato podría ser una opción coadyuvante para el manejo del síndrome de dolor lumbar crónico con síndrome de sensibilización central.

INTRODUCTION: The chronic low back pain causes severe dysfunction, treatment is complex and in some cases it can be refractory to usual treatment. Central Sensitivity syndrome secondary to chronic low back pain is characterized by anxious, depressive, sleep disorders, fatigue, eating disorders and damage in daily activities life. Management of this syndrome must be integrative and multidimensional. OBJECTIVES: Describe the use of topiramate in 25 patients with chronic low back pain for pain relief in refractory patients to standard treatment, during 12 weeks. MATERIALS AND METHODS: Following during 12 weeks, multiples Assessments about anxiety, depression, functionality, sleep quality, VAS pain and fatigue. Results: Median doses 300mg. 72 percent got pain relief, and decrease in anxious depressive symptoms, improve sleep quality, daily function. 16 percent didn't get pain relief and suffered adverse effects forcing suspension of the drug. 12 percent didn't get pain relief without adverse effects. DISCUSSION: Topiramate might be a treatment option for pain relief in these patients.

Effects of Antiepileptic Drugs on Language Abilities in Benign Epilepsy of Childhood with Centrotemporal Spikes

BACKGROUND AND PURPOSE: This study is to assess the responsiveness of electroencephalography (EEG) abnormalities and their effects on language ability after initiating different types of antiepileptic therapy in children with newly diagnosed benign epilepsy of childhood with centrotemporal spikes (BECTS). METHODS: The records of patients newly diagnosed with BECTS (n=120; 69 males) were reviewed retrospectively. The patients were randomly treated with lamotrigine, oxcarbazepine, or topiramate monotherapy, and underwent at least two EEG and standardized language tests. Effects were compared using Pearson’s chi-square tests and paired t-tests. RESULTS: The recurrence rates for seizures in the lamotrigine, topiramate, and oxcarbazepine groups were 19.4%, 21.7%, and 11.4%, respectively, while complete or partial recovery (as indicated by EEG) occurred in 32%, 39%, and 16% of the patients. Patients in the lamotrigine group showed significant improvements in all parameters assessed by the Test of Language Problem Solving Abilities, except for ‘determining cause.’ Patients in the oxcarbazepine group also showed improvements, except for ‘making inferences’ (p < 0.05). Most linguistic index scores were worse in the topiramate group except for Mean Length of Utterance in Words. Patients in the lamotrigine and oxcarbazepine groups showed significant improvements in the receptive language test (p < 0.05). EEG improvements were not related to language ability. CONCLUSIONS: The improvements in language and problem-solving performance in children with BECTS were greater for lamotrigine and oxcarbazepine than for topiramate. However, EEG remission did not imply that language function would be improved after the treatments.

Normal anion gap metabolic acidosis secondary to topiramate intake: case report

ABSTRACT Introduction: Topiramate is a drug used to treat various types of epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case presentation: 17-year-old female patient from Mexico City who regularly uses topiramate, quetiapine and sertraline for the management of depressive disorder. She developed normal anion gap metabolic acidosis secondary to topiramate intake. As a result, she required invasive ventilatory support due to reduced consciousness and respiratory distress. Adequate response to management with laxatives and bicarbonate was achieved, with full renal and neurological recovery. Discussion: Metabolic acidosis is the most common acid-base disorder observed in clinical practice. The difference between measurable cations and anions, known as anion gap, helps to classify the severity of acidosis. Bicarbonate losses or renal tubular disorders generate normal anion gap acidosis as opposed to acidosis resulting from an overproduction of endogenous acid or renal failure, which causes high anion gap. Topiramate is a little known cause of normal anion gap metabolic acidosis; by inhibiting carbonic anhydrase, it causes mixed renal tubular acidosis or type 3 acidosis, as a consequence of the inability to secrete hydrogen ions in the collecting tubule, and a limitation of bicarbonate reabsorption in the proximal tubule. Conclusion: Topiramate, either in therapeutic doses or in overdose, can lead to normal anion gap metabolic acidosis due to the inhibition of carbonic anhydrase in the kidneys. It is usually reversible after starting bicarbonate.

RESUMEN Introducción. El topiramato es un medicamento que se usa en el tratamiento de varios tipos de epilepsia y como profilaxis en casos de cefalea migrañosa. Entre sus mecanismos de acción, la inhibición de la anhidrasa carbónica en el riñón desencadena la excreción de orina alcalina ocasionando acidosis metabólica. Presentación del caso. Paciente femenino de 17 años procedente de la Ciudad de México con antecedente de consumo de topiramato, quetiapina y sertralina para manejo de síndrome depresivo, quien desarrolla acidosis metabólica de anión restante normal secundaria a ingesta de topiramato. La joven requiere soporte ventilatorio invasivo por deterioro del estado de conciencia y síndrome de dificultad respiratoria y presenta adecuada respuesta a manejo con catártico y bicarbonato sin compromiso renal y sin secuelas neurológicas. Discusión. La acidosis metabólica es la alteración ácido base más frecuente en la práctica clínica. La diferencia entre cationes y aniones medibles, conocida como anión restante o brecha aniónica, permite clasificar este tipo de acidosis. Las pérdidas de bicarbonato o trastornos de la función tubular renal generan acidosis de anión restante normal; por el contrario, la acidosis causada por sobreproducción de ácido endógeno o por insuficiencia renal genera anión restante elevado. El topiramato es una causa poco conocida de acidosis metabólica con anión restante normal; al inhibir la anhidrasa carbónica, se ocasiona una acidosis tubular renal mixta o tipo 3 debido a una in capacidad de secreción de hidrogeniones en el túbulo colector y una limitación en la reabsorción del bicarbonato en el túbulo proximal. Conclusión. El topiramato en dosis terapéutica o en sobredosis puede generar acidosis metabólica de anión restante normal debido a la inhibición de la anhidrasa carbónica a nivel renal. Se trata de un cuadro reversible en el cual el manejo con bicarbonato ha mostrado buenos resultados clínicos.

Clinical efficacy of carbamazepine, topiramate combined with levetiracetam in the treatment of traumatic refractory epilepsy / 中国医师进修杂志

Objective To study the effect of carbamazepine, topiramate combined with levetiracetam in the treatment of traumatic refractory epilepsy. Methods One hundred patients with traumatic intractable epilepsy from January 2014 to January 2017 were studied prospectively.They were divided into 2 groups by random digits table method with 50 cases each group.The control group received topiramate combined with carbamazepine, and the observation group was given carbamazepine, topiramate combined with levetiracetam treatment. All cases were treated for 6 months. The clinical efficacy of the 2 groups, patients with epilepsy, cognitive function score and the incidence of adverse reaction were compared. Results The total effective rate in observation group was 96% (48/50), in control group was 82% (41/50), and there was statistical difference (P<0.05). The number of seizures and epilepsy duration after treatment in observation group and control group were significantly lower than that before treatment: (2.84 ± 1.06) times/month vs. (6.18 ± 2.21) times/month and (4.09 ± 1.23) times/month vs.(6.24 ± 2.17)times/month,(1.25 ± 0.58)h/time vs.(2.75 ± 0.92)h/time and(1.97 ± 0.74) h/time vs. (2.83 ± 0.90) h/time, moreover those after treatment in observation group were significantly lower than those in control group,and there were statistical differences(P<0.05).The mini-mental state examination (MMSE) scores and Montreal cognitive assessment (MoC-A) scores after treatment in 2 groups were significantly higher than those before treatment, moreover those after treatment in observation group were significantly lower than those in control group, and there were statistical differences(P<0.05).There was no statistical difference in incidence of drug adverse reaction between control group and observation group:8%(4/50)vs.4%(2/50),P>0.05.Conclusions The clinical effect of carbamazepine, topiramate combined with levetiracetam on traumatic intractable epilepsy can effectively reduce the onset and duration of epilepsy,and improve the cognitive function of patients.The risk of adverse reactions did not increase.This treatment is reliable and safe.

Long-term follow-up study of topiramate in the treatment of symptomatic epilepsy in infants / 中国基层医药

Objective To observe the long-term efficacy and safety of topiramate in the treatment of symptomatic epilepsy in infants.Methods Fifty infants with symptomatic epilepsy were collected.The monotherapy was started with topiramate from April 2012 to April 2013,including 26 males and 24 females.The effective rate,retention rate and adverse effects after using the medication at 1 year,2 years,3 years,4 years were evaluated.Kaplan -Meier and Cox proportional hazards regression model were used to calculate the retention rate and analyze the risk factors for retention rate.Results From the beginning of using the medicine,the effective rate was 66.00％ at 1 year,61.90％ at 2 years,58.33％ at 3 years,and 53.33％ at 4 years,respectively.The rates of complete remission were 44.00％,42.86％,41.67％,36.67％ at 1 year,2 years,3 years,4 years,respectively.The main adverse effects of topiramate were drowsiness,hypodynamia,weight loss,anepithymia,vomit,diarrhea,hypohidrosis,slowly thinking active,attention disorders,etc.The retention rate was 84.00％ at 1 year,72.00％ at 2 years,60.00％ at 3 years,and 48.00％ at 4 years.The main causes of stopping medication were lower curative effect of topiramate monotherapy and side effects.Conclusion Topiramate in the treatment of infants with symptomatic epilepsy has good effect and safety,with higher retention rate in a long-term follow-up.The major factors that affect the retention rate are lower curative effect and adverse reactions.Slowly add quantity and low dose treatment can reduce adverse drug reactions,improve compliance and increase retention rate.