topiramate and Tourette-Syndrome

To assess the efficacy and safety of topiramate for children with Tourette syndrome.. Randomized controlled trials evaluating topiramate for children with Tourette syndrome were identified from the Cochrane library, PubMed, Cochrane Central, Embase, CBM, CNKI, VIP, WANG FANG database, and relevant reference lists. Two reviewers independently selected trials, assessed trial quality, and extracted the data. Disagreement was resolved by discussion. Quality assessment referred to the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1.).. Fourteen trials involving 1003 patients were included, of which 720 cases were male (71.8%). Ages were 2 to 17 years old. The general quality of included randomized controlled trials was poor. All trials were positive drug-controlled (12 randomized controlled trials used haloperidol as control, 2 used tiapride). The follow-up period was from 20 days to 12 months. Meta-analysis of 3 trials (n = 207), in which tics symptoms control was assessed by Yale Global Tic Severity Scale, suggested that there was significant difference in the mean change of Yale Global Tic Severity Scale score during the treatment period (mean difference = -7.74, 95% CI [-10.49, -4.99], I(2) = 0) between topiramate and control groups. Meta-analysis of 9 trials (n = 668) evaluating tics symptoms control ≥ 50% suggested that there was no significant difference in reduction of tics between topiramate and control group during the treatment period (relative ratio = 1.36, 95% CI [0.90, 2.06], I(2) = 0). Adverse events were reported in 13 trials. Drowsiness (3.3-16%), loss of appetite (4-16.7%), cognitive dysfunction (7.89-12.5%), and weight loss (6-10.5%) were common adverse events.. The current evidence is promising but not yet sufficient to support the routine use of topiramate for Tourette syndrome in children due to low quality of the study designs. It deserves to confirm in further high-quality, placebo-controlled trials.

Topics: Adolescent; Anticonvulsants; Child; Child, Preschool; Databases, Factual; Female; Fructose; Humans; Male; Randomized Controlled Trials as Topic; Topiramate; Tourette Syndrome; Treatment Outcome

To investigate the effects of topiramate on Tourette syndrome (TS).. Dopamine-receptor-blocking drugs have been traditionally used to control tics in patients with TS, but these neuroleptics are associated with potentially limiting side effects.. This is a randomised, double-blind, placebo-controlled, parallel group study. To be included in the study, subjects required a DSM-IV diagnosis of TS, were 7-65 years of age, had moderate to severe symptoms (Yale Global Tic Severity Scale (YGTSS) > or =19), were markedly impaired as determined by the Clinical Global Impression (CGI) scale severity score of > or =4 and were taking no more than one drug each for tics or TS comorbidities.. There were 29 patients (26 males), mean age 16.5 (SD 9.89) years, randomised, and 20 (69%) completed the double-blind phase of the study. The primary endpoint was Total Tic Score, which improved by 14.29 (10.47) points from baseline to visit 5 (day 70) with topiramate (mean dose 118 mg) compared with a 5.00 (9.88) point change in the placebo group (p = 0.0259). There were statistically significant improvements also in the other components of the YGTSS as well as improvements in various secondary measures, including the CGI and premonitory urge CGI. No differences were observed in the frequency of adverse events between the two treatment groups.. This double-blind, placebo-controlled trial provides evidence that topiramate may have utility in the treatment of moderately severe TS.

Topics: Adolescent; Adult; Aged; Child; Double-Blind Method; Female; Fructose; Humans; Male; Middle Aged; Neuroprotective Agents; Severity of Illness Index; Topiramate; Tourette Syndrome; Young Adult

Cystic fibrosis is the most common life-limiting genetic condition in Caucasians caused by Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene mutations. Sweat chloride is the current gold standard for diagnosis where values >60 mmol/L are diagnostic and values >30 mmol/L are indeterminate. There is limited literature on the effect of medications on the sweat chloride values. We report a case of topiramate being responsible for false-positive testing which resulted in overutilisation of medical resources and psychosocial stress on the family. Topiramate should be considered during the interpretation of the gold standard testing as one of the cause of false-positive sweat tests.

Topics: Adolescent; Anticonvulsants; Asthma; Chlorides; Cystic Fibrosis; False Positive Reactions; Female; Humans; Mass Screening; Sweat; Topiramate; Tourette Syndrome

The pathogenesis of Tourette syndrome (TS) is associated with the disorders of neurotransmitters, such as dopamine (DA) and excitatory amino acids (EAA). Antiepileptic drugs such as topiramate have shown some effects on TS, but the mechanism has not been clearly identified. The objective of the research was to evaluate the relationship between the pathogenesis of TS and abnormality of neurotransmitters by determining the levels of brain free DA and plasma EAA in iminodipropionitrile (IDPN) induced head twitch response (HTR) rats, and to investigate the effects of topiramate on HTR induced by IDPN.. Forty-eight Sprague-Dawley rats were randomly divided into six groups: blank control, TS model, and haloperidol-(0.5 mg/kg) and topiramate-treated (5, 10 and 20 mg/kg). HTR was induced by 7-day peritoneal injections of IDPN (150 mg/kg daily) and was used as TS model. Brain free DA levels and plasma levels of EAA were measured using ELISA and high performance liquid chromatography respectively 35 days after haloperidol or topiramate administration.. Brain free DA levels were significantly lower and plasma EAA levels were significantly higher in the TS model group compared with those in the blank control group (P<0.05). Topiramate of 10 and 20 mg/kg significantly decreased the frequency of IDPN-induced HTR and significantly increased the level of brain free DA when compared with the TS model group (P<0.05). Topiramate of 20 mg/kg treatment as haloperidol treatment significantly decreased plasma EAA levels compared with the TS model group (P<0.05).. The pathogenesis of TS is related to the super-sensitivity of DA receptor in the center nervous system and the over-effect of plasma EAA. Topiramate can reduce IDPN-induced HTR, probably through the inhibition of DA and DA-receptor combination in the brain and the secretion and release of plasma EEA.

Topics: Animals; Anticonvulsants; Behavior, Animal; Brain Chemistry; Dopamine; Excitatory Amino Acids; Fructose; Male; Rats; Rats, Sprague-Dawley; Topiramate; Tourette Syndrome

Topics: Adolescent; Child; Child, Preschool; Female; Fructose; Humans; Infant; Male; Topiramate; Tourette Syndrome

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Male; Topiramate; Tourette Syndrome; Treatment Outcome