topiramate and Cerebellar-Diseases

To evaluate the safety and potential beneficial effect of topiramate (TPM) as monotherapy or adjunctive therapy to carbamazepine (CBZ) in patients with cerebellar tremor.. Nine patients with cerebellar tremor participated a 4-week, open-label, prospective-controlled trial. TPM was given as monotherapy (n=7 cases), or in combination with CBZ (n=2 cases), at dosages ranging from 25 mg twice daily to 100 mg twice daily. The severity of tremor was assessed clinically on a 0-4 scale, by tremograms, by the Patients Global Impressions Scale, and by a "free writing" task at baseline and after 4 weeks.. TPM was discontinued in four patients due to adverse effects (sedation=2; cognitive impairment=2; increased aggressiveness=2; asthenia=1). During TPM, all patients improved. The mean tremor amplitude, compared with the baseline period, was reduced from 20% to 75%. After TPM, mean clinical scores of postural tremor and kinetic tremor decreased from 2.1+/-0.8 to 0.9+/-0.9 and from 2.1+/-1 to 1.4+/-1 (P<.05), respectively. All patients with head tremor improved. Writing, eating, and drawing were improved with TPM. Four patients chose to keep taking the drug.. Our study indicates that TPM may be useful for the management of cerebellar tremors. A prospective placebo-controlled trial of TPM in this kind of tremor is warranted. TPM dosages should be titrated slowly to avoid the potential side effects of the drug. The range and the frequency of adverse events might limit the clinical usefulness of TPM.

Topics: Adult; Aged; Cerebellar Diseases; Female; Fructose; Humans; Male; Middle Aged; Prospective Studies; Statistics, Nonparametric; Topiramate; Tremor

The cerebellar cognitive affective syndrome (CCAS) represents a spectrum of cerebellar-induced neurocognitive and affective disturbances. In this report a patient is described who developed CCAS under a treatment with standard daily dose of the anti-epileptic drug topiramate (TPM). Cognitive disturbances consisted of impaired visuo-spatial memory, concentration deficits and executive dysfunctions. Behavior and affect were characterized by marked mood-swings and several disinhibited symptoms. After a gradual discontinuation of treatment with topiramate, a complete remission of the cognitive and affective symptoms was observed within 6 weeks. Functional neuroimaging studies by means of SPECT were conducted 2 weeks and 8 months following TPM discontinuation. This case report seems to suggest that functional disruption of the cerebello-cerebral circuitry, leading to CCAS, can follow treatment with topiramate.

Topics: Amines; Anticonvulsants; Carbamazepine; Cerebellar Diseases; Cerebellum; Cognition Disorders; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Epilepsy; Female; Follow-Up Studies; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Middle Aged; Mood Disorders; Neuropsychological Tests; Oxcarbazepine; Syndrome; Topiramate; Treatment Outcome

Topics: Adult; Anticonvulsants; Astrocytoma; Cerebellar Diseases; Cerebellar Neoplasms; Electromyography; Fructose; Humans; Male; Postoperative Complications; Posture; Tomography, X-Ray Computed; Topiramate; Tremor