topiramate and Hallucinations

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

The hypothesis that exposure to traumatic events may sensitize or kindle limbic nuclei has led to efforts to treat posttraumatic stress disorder (PTSD) with anticonvulsants. Based on the kindling hypothesis of PTSD, this open-label study assesses clinical response to topiramate as a potential treatment for DSM-IV PTSD.. A naturalistic data review was conducted of medical records of all adult outpatients (9 men. 26 women symptomatic for a mean +/- SD of 18 +/- 15 years with DSM-IV chronic civilian PTSD) treated with topiramate, 12.5 to 500 mg/day, as add-on (N = 28) or monotherapy (N = 7). The last 17 patients completed the PTSD Checklist-Civilian Version (PCL-C) before treatment and at week 4. Dosage titration started at 12.5 to 25 mg/day and increased in 25- to 50-mg increments every 3 to 4 days until a therapeutic response was achieved or the drug was no longer tolerated. The mean duration of treatment was 33 weeks (range, 1-119 weeks).. Topiramate decreased nightmares in 79% (19/24) and flashbacks in 86% (30/35) of patients, with full suppression of nightmares in 50% and of intrusions in 54% of patients with these symptoms. Nightmares or intrusions partially improved in a median of 4 days (mean = 11 +/- 13 days) and were fully absent in a median of 8 days (mean = 35 +/- 49 days). Response was seen in 95% of partial responders at a dosage of 75 mg/day or less, and in 91% of full responders at a dosage of 100 mg/day or less. Mean reductions in PCL-C score from baseline to week 4 were highly significant (baseline score = 60 vs. week 4 score = 39, p < .001), with similar reductions in reexperiencing, avoidance, and hyperarousal criteria symptoms. Thirteen patients discontinued for various reasons during the > 2-year study period. Except for a single instance of acute secondary narrow-angle glaucoma, there were no serious side effects.. Topiramate appeared effective as add-on or monotherapy for chronic PTSD. It demonstrated a rapid onset of action and minimally serious, dose-related side effects without the development of tolerance. Double-blind studies are indicated.

Topics: Adolescent; Adult; Age of Onset; Aged; Anticonvulsants; Antipsychotic Agents; Bipolar Disorder; Chronic Disease; Comorbidity; Dose-Response Relationship, Drug; Dreams; Drug Administration Schedule; Drug Therapy, Combination; Female; Fructose; Hallucinations; Humans; Life Change Events; Male; Middle Aged; Personality Inventory; Stress Disorders, Post-Traumatic; Topiramate; Treatment Outcome

Many patients with Lewy body dementia develop visual hallucinations and other psychiatric symptoms. These patients are hypersensitive to antipsychotic drugs. Although patients tolerate atypical better than typical antipsychotics, both types can cause major extrapyramidal side effects. The anticonvulsant mood stabilizer topiramate, which does not cause parkinsonism, has been used as adjuvant therapy for both the positive and negative symptoms of schizophrenia; these symptoms can resemble those of Lewy body dementia. This report documents a 65-year-old woman with a 3-year history of progressive dementia that over the past 2 years had become complicated by severe extrapyramidal symptoms and agitated hallucinations. Her hallucinations became daily and were disrupting to her family. She was given a clinical diagnosis of Lewy body dementia after imaging and laboratory studies ruled out other etiologies. Treatment with olanzapine relieved her psychotic symptoms but caused severe dystonias, daily myoclonic jerks, and tremors. Stopping the olanzapine and starting topiramate 25 mg daily eliminated the hallucinations and agitation without worsening her extrapyramidal side effects. However, the topiramate was stopped because the patient reportedly developed anorexia and significant weight loss. Her hallucinations returned. When topiramate was reinstated at 12.5 mg a day, her agitation resolved, although her hallucinations continued. After 6 months on this dose, her agitation was still fairly well controlled without serious side effects or worsening of her parkinsonian symptoms.

Topics: Aged; Anticonvulsants; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Female; Fructose; Hallucinations; Humans; Lewy Body Disease; Neuroprotective Agents; Olanzapine; Psychomotor Agitation; Schizophrenia; Topiramate; Treatment Outcome

Various visual and sensory phenomena have been described in migraine with aura. Among those, the 'Alice in Wonderland' syndrome is defined as a distortion of the body image with the patient being aware of its unreal nature. Here, the case of a 17-year-old girl with migraine without aura who developed an 'Alice in Wonderland' syndrome repeatedly on topiramate treatment was presented and potential pathophysiological concepts were discussed.

Topics: Adolescent; Anticonvulsants; Body Image; Female; Fructose; Hallucinations; Humans; Migraine without Aura; Topiramate

Topics: Adult; Anticonvulsants; Cerebral Cortex; Electroencephalography; Epilepsy, Complex Partial; Face; Female; Fructose; Hallucinations; Humans; Illusions; Levetiracetam; Magnetic Resonance Imaging; Piracetam; Reflex; Topiramate; Valproic Acid

Topics: Adult; Anticonvulsants; Dose-Response Relationship, Drug; Female; Fructose; Hallucinations; Humans; Migraine Disorders; Topiramate

Topics: Adult; Afterimage; Anti-Obesity Agents; Feeding and Eating Disorders; Female; Fructose; Hallucinations; Humans; Topiramate

To describe the dose-concentration relationship of a continuous intravenous infusion of valproic acid (VPA) in pediatric patients when a dosing protocol is used.. Retrospective and concurrent chart review.. Tertiary care, 473-bed, academic medical center with a 120-bed, dedicated children's hospital.. Twenty-six pediatric patients (< 18 yrs old) who received VPA according to the protocol for continuous intravenous infusions between January 1, 2004, and March 31, 2006, identified by using a pharmacy order-entry system.. Patient demographics, VPA treatment regimens, clinical responses, and safety data were recorded and analyzed. Median patient age was 8.5 years (range 1.4-16 yrs). Approximately two thirds received VPA for seizures, and one third for migraines. Patients were given a mean +/- SD VPA loading dose of 28.5 +/- 5.2 mg/kg followed by a continuous infusion rate of 1 +/- 0.2 mg/kg/hour. Mean +/- SD serum concentration measured 4.5 +/- 1.6 hours after the loading dose was 83.3 +/- 22.8 microg/ml. Steady-state concentration at 23.3 +/- 3.0 hours after the start of the continuous infusion was 80.0 +/- 26.0 microg/ml. Postload and steady-state serum concentrations were within the target concentration of 50-100 microg/ml in 77% and 69% of patients, respectively. On further analysis, when the target range was expanded to 50-125 microg/ml (125 microg/ml was deemed acceptable if no adverse effects were noted), 89% and 92% of patients, respectively, had postload and steady-state VPA serum concentrations within this range. The response rate was excellent, with nearly 85% of patients achieving a complete or partial response to therapy. Adverse effects were generally mild and uncommon.. The continuous-infusion protocol permitted rapid intravenous loading of VPA in pediatric patients while minimizing adverse events and achieving concentrations in the upper region of the therapeutic range.

Topics: Administration, Oral; Adolescent; Anticonvulsants; Child; Child, Preschool; Drug Therapy, Combination; Drug Utilization Review; Female; Fructose; Hallucinations; Humans; Hyperammonemia; Infusions, Intravenous; Male; Medical Records; Metabolic Clearance Rate; Migraine Disorders; Phenobarbital; Phenytoin; Retrospective Studies; Seizures; Topiramate; Treatment Outcome; Valproic Acid

Topiramate is an anticonvulsant which has been used more and more in recent years in psychiatry as well. The undesirable effects that have been observed remain relatively mild under conditions of slow titration. Psychotic symptoms have been described in connection with the use of topiramate in individual cases, however. It is not known which concomitant circumstances favour the appearance of this side-effect, though. This is a report about a psychotic attack that happened for the first time and lasted for one night in a borderline patient who was treated with topiramate 250 mg/day shortly after the start of a febrile infection. After the infection had gone, topiramate was given again and titrated to 300 mg/day. No further psychotic symptoms were observed.

Topics: Adult; Anticonvulsants; Borderline Personality Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Fever of Unknown Origin; Fructose; Hallucinations; Humans; Male; Psychoses, Substance-Induced; Respiratory Tract Infections; Topiramate

Topics: Adult; Antipsychotic Agents; Fructose; Hallucinations; Humans; Male; Neuroprotective Agents; Prisons; Psychotic Disorders; Risperidone; Smell; Topiramate

Topics: Anticonvulsants; Dominance, Cerebral; Female; Fructose; Hallucinations; Humans; Illusions; Middle Aged; Occipital Lobe; Seizures; Topiramate; Treatment Outcome

To investigate breakthrough mania secondary to a right temporal lobe neoplasm in a bipolar patient previously stabilized on sodium divalproex.. Right hemispheric brain tumors involving the orbitofrontal or basotemporal cortex are a rare cause of secondary mania. In such cases, early neurologic signs may be difficult to distinguish from bipolar symptoms. Breakthrough mania secondary to brain neoplasm in a bipolar patient stabilized on medication is an extremely rare phenomena which has not been previously reported.. The clinical course of a bipolar subject stabilized on valproate who developed mania secondary to a right temporal lobe astrocytoma is described. Serial brain magnetic resonance imaging (MRI), baseline electroencephalogram (EEG), and neuropsychiatric evaluations were used to examine the relationship between the patient's brain mass and behavioral disturbances.. Symptoms were those that accompanied prior episodes of mania. In addition, signs of temporal lobe dysfunction were evident including periods of detachment, déjà vu experiences, and olfactory hallucinations. In the context of mania, depersonalization was initially attributed to bipolar symptoms. Only several months later, when olfactory hallucinations and alterations in consciousness became evident, was a temporal lobe lesion suspected. Neuropsychiatric abnormalities responded to a combination of surgical intervention, radiation therapy, and topiramate, however the tumor was advanced and invasive at diagnosis resulting in a poor prognosis.. This case suggests that clinicians examining unexplained cases of breakthrough mania should be vigilant for early signs of temporal lobe dysfunction, which could aid in detecting treatable lesions.

Topics: Anticonvulsants; Antimanic Agents; Astrocytoma; Bipolar Disorder; Brain Neoplasms; Disease Progression; Electroencephalography; Female; Fructose; Hallucinations; Humans; Magnetic Resonance Imaging; Middle Aged; Temporal Lobe; Topiramate; Valproic Acid

Topics: Agoraphobia; Alcoholism; Cyclohexanols; Depressive Disorder; Female; Fructose; Hallucinations; Humans; Infarction, Posterior Cerebral Artery; Middle Aged; Neuroprotective Agents; Obesity; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Topiramate; Venlafaxine Hydrochloride

Topics: Adult; Anticonvulsants; Female; Fructose; Hallucinations; Headache; Humans; Migraine Disorders; Psychoses, Substance-Induced; Topiramate

The incidence of psychosis during clinical trials of topiramate was 0.8%, not significantly different from the rate for placebo or reported rates of psychosis in patients with refractory epilepsy. We observed psychotic symptoms in five patients soon after initiation of topiramate therapy. We performed a retrospective chart review of the first 80 patients who began on topiramate after approval for clinical use, between January and April 1997. Symptoms suggestive of psychosis, including hallucinations and delusions, were sought for analysis. Cognitive effects such as psychomotor slowing, confusion, and somnolence were not included. Five patients developed definite psychotic symptoms 2 to 46 days after beginning topiramate. Dosages at symptom onset were 50-400 mg/day. Symptoms included paranoid delusions in four patients and auditory hallucinations in three. Symptoms of psychosis and other psychiatric symptoms resolved quickly with discontinuation of topiramate in three patients, dose reduction from 300 to 200 mg/day in one and with inpatient treatment and neuroleptics in another. One patient had a history of auditory hallucinations, one of aggressive and suicidal thoughts, but three had no significant psychiatric history. Physicians should be aware of the possibility of psychotic symptoms, even in patients without a previous psychiatric history, when prescribing topiramate. Symptoms resolve quickly with discontinuation.

Topics: Adult; Anticonvulsants; Delusions; Dose-Response Relationship, Drug; Epilepsy, Complex Partial; Epilepsy, Post-Traumatic; Epilepsy, Tonic-Clonic; Female; Fructose; Hallucinations; Humans; Male; Middle Aged; Patient Care Team; Prognosis; Psychoses, Substance-Induced; Retrospective Studies; Topiramate

The purpose of this study was to look at the efficacy and side effect profile of topiramate in a neurology unit. Using case notes, 94 patients who had been treated with topiramate were identified: 48 patients had taken part in clinical trials of topiramate, 46 received topiramate once licensed. Of these patients 24% had a greater than 50% decrease in seizure frequency. Patients with primary generalized epilepsy (n = 12) had a greater reduction in seizures compared with those with partial epilepsies (n = 70) P > 0.03. There was a high incidence (41%) of side effects, particularly psychiatric problems, leading to withdrawal of therpay in 41% of patients. Seven patients were admitted to hospital as a result of psychotic symptoms or depression. The incidence of psychotic symptoms (12%) was significantly higher for patients receiving topiramate compared with 191 patients attending the department on gabapentin (0.5%) and 270 patients attending the department on lamotrigine (0.7%) P < 0.001. 'Abnormal thinking', consisting of mental slowing and word-finding difficulties, occurred in 31%. The incidence could be significantly reduced by using 25 mg dose increments fortnightly as opposed to 100 mg weekly (P > 0.03). Although topiramate is an effective antiepileptic drug, its use is accompanied by a high incidence of particularly psychiatric side effects.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Anticonvulsants; Child; Cognition; Depression; Epilepsy; Female; Fructose; Hallucinations; Humans; Male; Medical Audit; Memory; Middle Aged; Neurology; Psychoses, Substance-Induced; Retrospective Studies; Topiramate; United Kingdom