Topiramate Related Cognitive Dysfunction during Migraine Prevention

ABSTRACT

BACKGROUND: Topiramate (TPM), a broad-spectrum antiepileptic drug, has recently been demonstrated to be effective as a monotherapeutic device for migraine prevention. We investigated the impact of TPM on cognition during migraine prevention. METHODS: Twenty-eight migraineurs were evaluated. They were instructed to take 25 mg of TPM per day, with 25 mg weekly increments to a maximum of 100 mg per day according to the therapeutic responsiveness. We assessed cognitive dysfunctions by spontaneous patient reports and several neuropsychological tests comparing the baseline and at 3 months during on-treatment. We also compared these tests to age, sex, education, clinical features of migraine, TPM dose, and global effectiveness. RESULTS: After 3 months of therapy, 21 patients undertook a follow-up neuropsychological test. Even though headache frequency, severity, and disability were significantly decreased in a follow-up period, there was a significant impairment in backward digit span (P=.006) and verbal fluency (P=.023). Thirteen patients (62%) showed an impaired backward digit span, and 11 patients (52%) exhibited an impaired verbal fluency. Five patients (24%) complained of symptoms associated with these impairments. Cognitive impairments were well correlated to the frequency of migraine attack, higher daily TPM dose, and global effectiveness. In six patients who showed the impairment of both items, TPM was withdrawn and their cognition was retested after 2 weeks. There was a significant improvement in these cognitive functions. CONCLUSIONS: TPM appears to exert a dose-related, strong negative influence on working memory and verbal fluency during migraine prevention. It can be related to drug tolerability.