Toxins in Neuro-Ophthalmology
Vivek Lal in 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.
Neuropeptide Regulation of Ion Channels and Food Intake
Tian-Le Xu, Long-Jun Wu in Nonclassical Ion Channels in the Nervous System, 2021
Topiramate is a sulfamate modified fructose diacetonide that affects multiple ion channels and receptors including voltage-gated sodium and calcium channels, GABAA receptor, and AMPA/kainite glutamate receptors. Topiramate has been approved by the FDA for weight loss management. Topiramate as monotherapy causes 6%–7% more body weight loss compared to placebo, whereas it has 9%–10% more weight loss compared to placebo after 1 year of treatment when combined with phentermine (Kopelman et al. 2010; Wong, Sullivan, and Heap 2012). Although the mechanism remains unclear, topiramate may inhibit food intake through direct modulation of ion channels in feeding-related neurons and indirect increase in the expression of feeding-related neuropeptides such as POMC and TRH, as well as potentiation of insulin and leptin signaling in the hypothalamus (Caricilli et al. 2012).
Chronic Headache Pain
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
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
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.
The use of off-label medications in substance abuse treatment programs
Published in Substance Abuse, 2020
Maria Paino, Lydia Aletraris, Paul M. Roman
Topiramate is an anticonvulsant used to treat seizures and migraines. Topiramate is an effective treatment for alcohol, nicotine, and cocaine dependence.9 In a meta-analysis, research shows that topiramate is superior to a placebo, and indirect comparisons suggest it is superior to naltrexone, acamprosate, and nalmefene.23 The growing body of evidence that topiramate is effective for treating alcohol use disorders (AUDs) has led to research in the use of topiramate for other SUDs.24,25 In a series of clinical trials, topiramate (used in conjunction with cognitive behavioral therapy) was found to reduce short-term cocaine-use and increase abstinence.26–31 While the efficacy of topiramate is promising, there are many side effects associated with its use (eg, dizziness, paresthesia, memory impairment).20 Much like divalproex, however, the relative effectiveness of topiramate for treating clients with cocaine use disorders may result in treatment centers increasing their use of this medication off-label.
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