Abnormal wada and neuropsychological testing results due to topiramate therapy

A 46-year-old man experienced intractable seizures since childhood. Due to lack of response to antiepilepsy drugs (AEDs), he underwent a surgical eval uation that was consistent with seizure onset in the left medial temporal l obe. While on topiramate and carbamazepine, his preoperative neuropsycholog ical scores and sodium amytal (Wada) scores were low and may have excluded him from surgery. Repeat testing on lamotrigine and carbamazepine showed im provement in his scores, allowing him to undergo surgery. Physicians must t herefore be cautious in evaluating such test scores while a patient is on t opiramate.