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Toxins in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Topiramate, an oral anticonvulsant, is used for the treatment of seizures, prophylaxis for migraine, as well as off-label in the treatment of bipolar disorder. Ocular toxicity will lead to blurred vision, eye pain and headache. Examination shows diffuse corneal edema, shallowing of the anterior chamber and significantly raised intraocular pressure (IOP) with retinal striae. Uveal effusion or ciliary edema leads to forward displacement of the lens–iris diaphragm and thickening of the lens by relaxation of zonules. This lead to anterior chamber shallowing and induced myopia, while retinal striae are caused by vitreoretinal traction. While many of the changes are reversible with prompt cessation of the drug, cycloplegic agents are often used to reverse the anterior displacement of the lens–iris diaphragm.
Antimanic Drugs
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Topiramate is a novel anticonvulsant drug and used in the treatment of migraine and bipolar disorder. As it causes weight loss, so it is used as addition to mood stabilizers. Topiramate is diversely acting drug making different from other anticonvulsant drug, that is, causes potentiation of GABA activity and declining glutamate activity by interfering with sodium and calcium channel function. The topiramate has weak mood stabilizing property in manic phase and maintenance phase of bipolar disorder as that of valproic acid and carbamazepine. In addition, topiramate is a weak inhibitor of carbonic anhydrase (Golan, 2012; Brunton et al., 2011; Katzung et al., 2009).
Chronic Headache Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
RuthAnn R. Lester, Eleanor S. Brammer, Allison Gray
Antiepileptic medications generally are well tolerated but can cause side effects that may lead to non-compliance. Migraine headaches and seizures appear to have similar biologic characteristics, and medications that lower hyperexcitability are helpful in reduction of events (Rothrock, 2012). Topiramate can cause weight loss, renal calculi, word finding issues, and paresthesias in hands and feet, but also can offer significant effectiveness in preventing migraine headaches. Useful in patients as young as 12 years, it has been approved by the Federal Drug Administration for prevention of migraine headaches (Huntington, 2005). It should be used with caution in menstruating women given risk of teratogenicity should a female patient on Topiramate become pregnant. Valproic acid often is highly effective in preventing migraines, but also should be used with caution with women of childbearing age due to potential teratogenicity in pregnancy. Valproic acid is a good mood stabilizer and can offer benefit for patients with comorbid mood disorders.
Different Characteristics of Pre-Pubertal and Post-Pubertal Idiopathic Intracranial Hypertension: A Narrative Review
Published in Neuro-Ophthalmology, 2023
Hannah S. Lyons, Sophie L. P. Mollan, Grant T. Liu, Richard Bowman, Mark Thaller, Alexandra J. Sinclair, Susan P. Mollan
Topiramate is an alternative medication to acetazolamide and has been investigated in an open-label study in adults.89 Topiramate has the additional benefit of being a useful migraine preventative. It is recommended in adults with IIH and chronic migraine-like headaches.90 Topiramate has been used safely in the paediatric population as an anti-epileptic medication.91 The standard regimen in children is 1.5–3 mg/kg per day in two divided doses and can be titrated slowly up over weeks to 200 mg per day.25 At higher doses (>200 mg/day), topiramate can reduce the efficacy of the oral contraceptive pill, which is important to consider in post-pubertal females.92 Topiramate should be avoided in pregnancy due to teratogenic effects.93
Safety and tolerability of preventive treatment options for chronic migraine
Published in Expert Opinion on Drug Safety, 2021
Amanda Tinsley, John Farr Rothrock
As indicated at the outset of this review, relative to males, female migraineurs are more likely to experience CM and thus greater migraine-related disability [3,78]. For all the available evidence-based CM prophylactic therapies, safety data for fertility, lactation/breast-feeding and pregnancy are either lacking, limited or, in the case of topiramate, cause for concern [Table 1]. Special consideration and patient counseling are needed for all women of child-bearing potential prior to prescribing these treatments. Albeit with little in the way of scientific basis, it generally is recommended that five half-lives pass after a medication of concern is stopped prior to attempting conception. If one chooses to adhere to this recommendation, in the relevant setting a medication’s half-life may be critical to the choice of treatment. For example, the anti-CGRP monoclonal antibodies have a half-life of 27–31 days, and if the five half-life recommendation is to be followed, approximately 6 months will need to pass following cessation of treatment before conception can be attempted. In contrast, with topiramate IR fewer than 5 days would be required after discontinuation. As such, for a woman planning pregnancy in 3–6 months topiramate may be a better choice for CM prevention/suppression than onabotA or a CGRP mab. A patient’s short- and long-term pregnancy and lactation/breast-feeding plans may influence choice of prevention therapy.
Second generation antipsychotic-induced weight gain in youth with autism spectrum disorders: a brief review of mechanisms, monitoring practices, and indicated treatments
Published in International Journal of Developmental Disabilities, 2021
Jeffrey Goltz, Iliyan Ivanov, Timothy R Rice
To our knowledge, only two RCTs exist analyzing different pharmacotherapy for SGA-induced weight gain in youth. In a study designed to test the efficacy of topiramate as an adjunct to risperidone for treating irritability symptoms, Rezaei et al. (2010) performed an 8-week double-blind, placebo-controlled RCT with 40 children ages 4–12 with ASD. The dose of topiramate used was 100–200 mg per day, which was based on weight. In their secondary analysis of side effects, they found no significant difference in changes in weight between groups. In addition, Canitano’s (2005) open label trial of treating SGA-induced weight gain in 10 youth with ASD with topiramate demonstrated mixed results. However, its use in open label trials with other psychiatric illnesses have yielded more positive results (Tramontina et al.2007, Wozniak et al.2009). Also, a recent retrospective review looked at the results of using topiramate or zonisamide for the treatment of SGA-induced weight gain (Shapiro et al.2015). It looked at 47 youth with a variety of psychiatric diagnoses (Major Depressive Disorder was most common). An average reduction of BMI from 1.3 to 4.1 per 6 months of treatment with use of topiramate or zonisamide was noted. However, there was no significant difference in weight loss noted between these two medications.