topiramate and Edema

Secondary angle-closure glaucoma with pupillary block can be related with anticholinergic drugs or sympathicomimetics alpha1. Secondary angle-closure glaucoma with ciliary body oedema is predominantly related with Topiramate.

Topics: Acute Disease; Cholinergic Antagonists; Ciliary Body; Edema; Fructose; Glaucoma; Glaucoma, Angle-Closure; Humans; Sympathomimetics; Topiramate; Uveitis

Brain edema is a common complication of brain metastases (BM) and associated treatment. The extent to which cytotoxic edema, the first step in the sequence that leads to ionic edema, vasogenic edema, and brain swelling, contributes to radiation-induced brain edema during BM remains unknown. This study aimed to determine whether radiation-associated treatment of BM induces cytotoxic edema and the consequences of blocking the edema in preclinical models of breast-cancer brain metastases (BCBM).. Using in vitro and in vivo models, we measured astrocytic swelling, trans-electric resistance (TEER), and aquaporin 4 (AQP4) expression following radiation. Genetic and pharmacological inhibition of AQP4 in astrocytes and cancer cells was used to assess the role of AQP4 in astrocytic swelling and brain water intake. An anti-epileptic drug that blocks AQP4 function (topiramate) was used to prevent cytotoxic edema in models of BM.. Radiation-induced astrocytic swelling and transient upregulation of AQP4 occurred within the first 24 hours following radiation. Topiramate decreased radiation-induced astrocytic swelling and loss of TEER in astrocytes in vitro, and acute short-term treatment (but not continuous administration), prevented radiation-induced increase in brain water content without pro-tumorigenic effects in multiple preclinical models of BCBM. AQP4 was expressed in clinical BM and breast-cancer cell lines, but AQP4 targeting had limited direct pro-tumorigenic or radioprotective effects in cancer cells that could impact its clinical translation.. Patients with BM could find additional benefits from acute and temporary preventive treatment of radiation-induced cytotoxic edema using anti-epileptic drugs able to block AQP4 function.

Topics: Aquaporin 4; Astrocytes; Brain; Brain Edema; Brain Neoplasms; Breast Neoplasms; Edema; Female; Humans; Topiramate

The case of a 20 year old female presenting with overnight acute loss of vision is reported. The patient was recently started on topiramate (Hitop) for her recurrent migraine and developed sudden loss of vision due to acute myopia. Topiramate was discontinued and the patient's vision returned to normal. Delayed and incorrect treatment may result in permanent vision loss, secondary to angle closure glaucoma; therefore it is imperative that prescribing physicians are aware of this rare but serious ocular emergency.

Topics: Edema; Female; Fructose; Glaucoma, Angle-Closure; Humans; Myopia; Neuroprotective Agents; Topiramate; Young Adult