topiramate and Heat-Stroke

Heatstroke is a life-threatening condition defined by failure of heat load dissipation, resulting in a core temperature higher than 40 °C (104 °F) associated with neurological dysfunction. Topiramate may cause anhidrosis, potentially resulting in heatstroke, as reported especially in children.. A 57-year-old Caucasian man was admitted to the emergency room in a febrile comatose state. After a complete workup ruling out the usual etiologies of such a condition, we assumed the hypothesis of a heatstroke caused by topiramate, recently prescribed for essential tremor.. Topiramate-related heatstroke has been described in children but must be recognized in adults as well. Outcomes may range from total clinical recovery to persistent neurological dysfunction or death. The prescription of topiramate and the follow-up of adult patients under this medication should include an evaluation of hypohidrosis, especially in contexts of high temperature.

Topics: Anticonvulsants; Essential Tremor; Fructose; Heat Stroke; Humans; Male; Middle Aged; Topiramate

Heat stroke is the most severe pathology related to heat. It is defined as an increase in core body temperature accompanied by signs of neurological dysfunction. In the absence of an early treatment, it has a very high mortality rate. Topiramate is a well known drug widely used in epilepsy treatment and migraine prevention. Oligohydrosis has been described amongst topiramate side effects, favouring the risk of hyperthermia and heatstroke. We present the case of a patient who developed heat stroke due to physical exercise while under topiramate treatment.

Topics: Child; Female; Fructose; Heat Stroke; Humans; Topiramate

Topics: Adult; Anticonvulsants; Coma; Diffusion Magnetic Resonance Imaging; Epilepsy; Fructose; Glasgow Coma Scale; Heat Stroke; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Topiramate

A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and "very hot to touch" by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2°C. His skin was hot and dry, without rash; physical examination was otherwise normal. Laboratory studies revealed severe metabolic acidosis with acute renal failure and rhabdomyolysis. In spite of sedation, intubation, and aggressive cooling measures, the patient had cardiac arrest and died approximately 2 hours after arrival. Serum topiramate and valproate concentrations were within therapeutic ranges at 8.8 μg/mL (therapeutic 2-12) and 97 μg/mL (therapeutic 50-100), respectively.

Topics: Adult; Anticonvulsants; Epilepsy; Fatal Outcome; Fructose; Heat Stroke; Humans; Male; Topiramate

Heatstroke, which is a major disorder related to environmental hyperthermia, is a rare event in children. The risk is increased with predisposing medical conditions and specific medications. We report the case of a 10-year-old epileptic patient, who received topiramate. Topiramate causes hypohydrosis and hyperthermia. We suggest that topiramate treatment may be a risk factor for heatstroke.

Topics: Child; Epilepsy; Fructose; Heat Stroke; Humans; Male; Neuroprotective Agents; Risk Factors; Topiramate

Topics: Adult; Aged; Female; Fructose; Heat Stroke; Humans; Male; Topiramate