TOPIRAMATE - SAFETY AND TOLERABILITY

Topiramate is a new novel drug for the treatment of intractable seizur es that is to be used in an adjunctive fashion. A review of the seven double-blind controlled studies was undertaken with special attention paid to safety and tolerability data. The studies were similar in desi gn but used varying doses of the drug. To date there has been no evide nce of serious systemic side effects such as rash, hepatotoxicity, car diotoxicity: serious gastrointestinal toxicity or aplastic anemia. Ren al stones were reported in 1.5% of patients with over 80% choosing to remain on the drug because of an improved quality of life. The unique observation of ''abnormal thinking'' was seen that seemed to be relate d to high doses and introducing the drug to rapidly. Patients, rather than describing psychomotor slowing, described a phenomenon of slow th oughts, decreased cognition, intermittent difficulty calculating, dull ed thinking, blunted mental reactions. Lastly, weight loss appears in approximately 10-20% of patients and is probably related to dulling of appetite. Although increasing doses gave increasing degrees of seizur e freedom, it appeared that doses beyond 600 mg/day are often not well tolerated.