topiramate and Poisoning

Topiramate is an FDA-approved second generation antiepileptic drug with actions on voltage-dependent sodium and calcium channels and GABA and excitatory amino acid receptors. There has only been one prior pediatric case report of topiramate toxicity. We report a 33-month-old girl with persisting neurologic symptoms after acute ingestion of topiramate.. A 33-month-old girl was found at her sitter'shouse with a bottle of topiramate (100-mg tablets). She presented to the emergency department 3 days post-ingestion. The child appeared confused and was only able to crawl. At one point, she looked directly at mother and asked, "Where is my mommy?" She had visual hallucinations and screamed while pointing to objects on the wall. Neurologic exam was notable for the slurred speech and severe ataxia. All laboratory testing, urine chemical dependency screen, CSF, chest X-ray, head CT, and EEG showed no abnormalities. Topiramate level on the third day post-ingestion was 9.4 mcg/mL, and 4.2 mcg/mL on the fourth day. Patient became oriented to family and regained normal gait on the fourth day. Her slurred speech persisted until the sixth day after ingestion.. Topiramate is an anti-epileptic drug with multifactorial mechanisms of action not entirely understood. We report here a 33-month-old girl with prolonged neurologic symptoms including hallucination, slurred speech, and severe ataxia after acute topiramate ingestion. This is the first pediatric case report of hallucination and prolonged neurologic symptoms with acute topiramate ingestion.

Topics: Acute Disease; Anticonvulsants; Child, Preschool; Drug Overdose; Female; Fructose; Humans; Neurotoxicity Syndromes; Poisoning; Recovery of Function; Topiramate

According to the best of our knowledge this is the first case of intoxication with topiramate in Polish medical literature. A case of a 15-year-old female who tried to commit suicide with 450 mg of Topamax was described. There were no significant changes in the medical examination as well as biochemical results. An agitation which transformed into bradykinesia and bradyphasia and lasted for about 24 hours were the only complaints of the patient.

Topics: Acute Disease; Adolescent; Anticonvulsants; Depression; Drug Overdose; Epilepsy; Female; Fructose; Humans; Poisoning; Suicide, Attempted; Time Factors; Topiramate; Treatment Outcome

Topiramate (Topamax) is an anti-epileptic medication for which acute toxicity is infrequently reported. A 5-yr-old girl, not previously taking topiramate, developed neurological symptoms after acute ingestion of this medication. She was intermittently agitated, complained of "not being able to feel anything," demonstrated arching movements of the back, and perseverated upon questioning. Computerized tomography of the head and electroencephalography were both normal, and urine toxicology testing for drugs of abuse was negative. A serum topiramate level was 10.5 mcg/mL, confirming the ingestion. The patient was observed for 24 h, over which time her symptoms completely resolved.

Topics: Acute Disease; Anticonvulsants; Child, Preschool; Female; Fructose; Humans; Neurotoxicity Syndromes; Poisoning; Topiramate