topiramate and Postoperative-Complications

On the basis of the relevance of adequate epilepsy treatment (antiepileptic drugs, surgery and vagus nerve stimulation) for people with intellectual disabilities, all articles, published from the beginning of 2005 to March 2006 and searched by MEDLINE, on this topic were reviewed.. On pharmacological treatment of epilepsy in people with intellectual disabilities, there were two articles on topiramate and one on levetiracetam. Two studies described the effect of surgical interventions, one of epilepsy surgery in the narrow sense and one of vagus nerve stimulation. Two papers were published on clinical conditions and therapeutic aspects of Angelman syndrome. They highlight the importance of gamma-aminobutyric acidergic mechanism in Angelman syndrome and the antiepileptic drug effects in this syndrome.. A contradiction exists between the relevance of epilepsy treatment in people with intellectual disabilities and the small number of published studies on pharmacological treatment. Some of the reasons are addressed and some alternatives are proposed.

Topics: Anticonvulsants; Brain; Electric Stimulation Therapy; Epilepsy; Fructose; Humans; Intellectual Disability; Levetiracetam; Neurosurgical Procedures; Piracetam; Postoperative Complications; Topiramate; Vagus Nerve

Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy.. A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded.. The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed.. Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.

Topics: Adult; Anticonvulsants; Dose-Response Relationship, Drug; Drug Monitoring; Drug Therapy, Combination; Epilepsy; Female; Humans; Male; Neurosurgical Procedures; Outcome and Process Assessment, Health Care; Postoperative Complications; Topiramate; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Anticonvulsants; Drug Interactions; Epilepsy; Female; Fructose; Humans; Meropenem; Peritonitis; Postoperative Complications; Thienamycins; Topiramate; Valproic Acid

The authors report on the case of a 6-week-old boy who presented with infantile spasms. At 2.5 months of age, the patient underwent a right hemispherectomy. Approximately 3 months postoperatively, the patient presented with left coronal craniosynostosis. Subsequent cranial vault remodeling resulted in satisfactory cosmesis. Four years after surgery, the patient remains seizure free without the need for anticonvulsant medications. The authors believe this to be the first reported case of iatrogenic craniosynostosis due to hemispherectomy, and they describe 2 potential mechanisms for its development. This case suggests that, in the surgical treatment of infants with intractable epilepsy, minimization of brain volume loss through disconnection techniques should be considered, among other factors, when determining the best course of action.

Topics: Adrenocorticotropic Hormone; Anticonvulsants; Clonazepam; Craniosynostoses; Craniotomy; Electroencephalography; Epilepsy; Fructose; Hemispherectomy; Humans; Infant; Male; Postoperative Complications; Spasms, Infantile; Tomography, X-Ray Computed; Topiramate

Topics: Adult; Anticonvulsants; Astrocytoma; Cerebellar Diseases; Cerebellar Neoplasms; Electromyography; Fructose; Humans; Male; Postoperative Complications; Posture; Tomography, X-Ray Computed; Topiramate; Tremor

Spinal segmental myoclonus rarely occurs in peripheral neurological disorders. There are no data about the efficacy of topiramate (TPM) on spinal myoclonus. We describe a patient whose segmental myoclonus in amputation stump was ameliorated markedly by TPM.

Topics: Aged; Amputation Stumps; Amputation, Surgical; Anticonvulsants; Diagnosis, Differential; Fructose; Humans; Ischemia; Leg; Male; Myoclonus; Postoperative Complications; Spinal Cord; Topiramate

The authors report a 51-year-old women with pharmacoresistant partial epilepsy who tolerated well valproate monotherapy and in combination with several other antiepileptic drugs, but developed symptoms and signs of reversible hepatic failure under a combination of valproate and topiramate. Symptoms resolved after discontinuation of VPA. This case provides further anecdotal evidence that topiramate may increase the risk of liver failure when given in combination with other potentially hepatotoxic antiepileptic drugs.

Topics: Anticonvulsants; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Epilepsies, Partial; Female; Fructose; Humans; Intracranial Aneurysm; Liver Function Tests; Middle Aged; Postoperative Complications; Topiramate; Valproic Acid

Topics: Aged; Anticonvulsants; Drug Resistance; Electroencephalography; Epilepsy, Complex Partial; Female; Fructose; Humans; Nephrectomy; Postoperative Complications; Recurrence; Topiramate