Anticonvulsant Agents: Topiramate View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2021-11-23

AUTHORS

Vera Dinkelacker , Maria Paola Valenti , Edouard Hirsch

ABSTRACT

Topiramate (TPM) is a sulfamate-substituted monosaccharide with multiple putative mechanisms of action, including voltage-gated sodium channels, high-voltage-activated calcium channels, GABA-A receptors, AMPA/kainate receptors, and carbonic anhydrase isoenzymes. TPM has proven to be effective through a wide series of trials in monotherapy and add-on therapy in focal epilepsies in adults and children. TPM is also effective in epilepsy with generalized seizures and may help in some epileptic encephalopathies such as Lennox-Gastaut and Dravet Syndromes. Good efficacy with fare tolerability and a relatively safe profile is obtained at doses of 100–200 mg/day in adults and ~3.5 mg/kg/day in children. Slow titration of TPM to a low-medium dosage will enhance tolerability. Furthermore, long-term follow-up studies indicate that the response to TPM is durable. Known interactions with other drugs are modest and rarely of clinical significance, apart from mild induction on estroprogestative contraceptive drugs. Note however that the association of TPM with valproate may induce encephalopathy with hyperammonemia. One major limitation of TPM-treatment is cognitive side effects (such as slowing in verbal fluency) as well as paresthesia, depression, and significant weight loss, notably in adult patients. TPM also increases the risk of nephrolithiasis, acidosis, and vision disturbances. During pregnancy, TPM conveys a significantly higher risk of major malformations as other antiepileptic drugs (AEDs) such as Lamotrigine and Levetiracetam and is therefore of limited use in women of childbearing age.In sum, even if TPM offers a valid therapeutic option in a wide spectrum of seizures, its safety profile should be individually monitored. The most suitable indications for use of TPM are patients suffering from both focal seizures and migraine comorbidity as well as children with Dravet syndrome. More... »

PAGES

1-15

Book

TITLE

NeuroPsychopharmacotherapy

ISBN

978-3-319-56015-1
978-3-319-56015-1

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-56015-1_308-1

DOI

http://dx.doi.org/10.1007/978-3-319-56015-1_308-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1143323847


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