topiramate and Chronic-Pain

High prevalence of chronic pain in elderly results in active search of new approaches for the effective and safe management of this category of patients. Antiepileptic drugs may provide analgesic affect in different types of chronic pain (mainly, in neuropathic pain). Variety of antiepileptics used as analgesics have variable efficacy and safety profile in elderly. «Old» antiepileptics (phenobarbital, clonazepam, ethosuximide, carbamazepine, phenytoin, valproate, etc.) and «new» (gabapentin, pregabalin, oxcarbazepine, lamotrigine, levetiracetam, topiramate, zonisamide, tiagabine) are considered in this review with insights on pharmacokinetic features of these drugs in elderly, profile of side effects, parameters of analgesic efficacy.. Высокая распространенность хронической боли в пожилом возрасте обусловливает активный поиск новых подходов для эффективного и безопасного ведения этой категории пациентов. Противоэпилептические препараты могут оказывать обезболивающее действие при различных видах хронической боли (преимущественно при невропатической). Различные противоэпилептические средства, используемые в качестве анальгетиков, обладают вариабельной эффективностью и безопасностью у пожилых людей. В обзоре рассматриваются «старые» противоэпилептические средства (фенобарбитал, клоназепам, этосуксимид, карбамазепин, фенитоин, вальпроат и другие) и «новые» (габапентин, прегабалин, окскарбазепин, ламотриджин, леветирацетам, топирамат, зонисамид, тиагабин) с учетом особенностей их фармакокинетики у пожилых пациентов, профиля безопасности и параметров анальгетической эффективности.

Topics: Aged; Analgesics; Anticonvulsants; Chronic Pain; Humans; Levetiracetam; Topiramate

Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM.. Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results. Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.

Topics: Biofeedback, Psychology; Botulinum Toxins, Type A; Chronic Pain; Cognitive Behavioral Therapy; Electric Stimulation Therapy; Fructose; Humans; Migraine Disorders; Neuroprotective Agents; Quality of Life; Relaxation Therapy; Topiramate; Transcranial Direct Current Stimulation; Treatment Outcome; Vagus Nerve Stimulation

Topiramate is a medication that is approved as both monotherapy and adjunctive treatment of seizure disorder in adults and adolescents. It is also approved for migraine prophylaxis. It has been associated with many side effects, including weight loss and the development of renal stones. It has also been associated with various central nervous system side effects such as dizziness, nervousness, parasthesias, and fatigue. Less commonly, it has been associated with the development of psychotic symptoms such as hallucinations.. To describe the relationship between the administration of topiramate and the development of hallucinations in this patient.. We will now present the case of a 32-year-old man who developed auditory hallucinations after initiating a relatively low dose of topiramate (25mg twice daily) for the treatment of chronic pain. We will review the prior cases of topiramate induced hallucinations, and discuss how these cases compare to the case we have described. We will review the treatment of these hallucinations.. In this case, there was a close temporal relationship between the initiation of topiramate and the onset of auditory hallucinations.. This case supports the previous reports describing the association between the use of topiramate and the developmenrt of hallucinations. Although the average daily topiramate dose associated with the development of hallucinations in previously reported cases was 150 mg in women and 181 mg in men, hallucinations can occur at lower doses (as low as 50 mg daily) as well.

Topics: Adult; Anticonvulsants; Chronic Pain; Fructose; Hallucinations; Humans; Male; Neuroprotective Agents; Topiramate

Topiramate is an approved drug to treat seizures, but its indications have been extended to other diseases of the nervous system and as an adjuvant to chronic pain. We present four cases of topiramate-induced nephrolithiasis from 2006-2012 in women whose treatment was prescribed for pain control and as a mood stabilizer at doses of 250-300 mg/day. In two cases, the lithiasis was caused by calcium phosphate (patite) and in the other two cases by oxalate and calcium phosphate. The most common metabolic alteration was an alkaline pH, followed by hypocitraturia. The drug was discontinued in two patient; it was reduced in one and was maintained in the fourth. An increase in fluid and potassium citrate intake was prescribed. In patients starting treatment with topiramate, an adequate control and prevention of nephrolithiasis should be performed due to the risk of mixed tubular acidosis and hypocitraturia. to the risk of mixed tubular acidosis and hypocitraturia.

Topics: Adult; Aged; Analgesics; Calcium Oxalate; Calcium Phosphates; Chronic Pain; Citric Acid; Female; Fructose; Humans; Hypercalciuria; Kidney Calculi; Middle Aged; Nephrolithiasis; Personality Disorders; Potassium Citrate; Psychotropic Drugs; Topiramate