topiramate and Vertigo

Migraine is a complex disorder with many different manifestations. There has been an increasing interest in the association of migraine and vertigo. Many different terms have been developed to describe this concept, the more popular being vestibular migraine, migrainous vertigo, and migraine-associated vertigo. The most commonly cited diagnostic criteria are that of Neuhauser though this has yet to be included in the International Classification of Headache Disorders (2nd edition). At this time, there is a lack of consensus regarding migraine-related vertigo and its pathomechanism. Regardless, a few randomized controlled prospective studies have been performed to evaluate the efficacy of various medications. Topiramate has been shown to be effective for migraine-related vertigo. At this time there is no specific treatment for migraine-related dizziness outside of conventional migraine management. The genetics have yet to be fully realized though an autosomal dominant familial migraine vertigo disorder has been identified.

Topics: Animals; Comorbidity; Dizziness; Fructose; Genetic Predisposition to Disease; Humans; Kindling, Neurologic; Migraine Disorders; Models, Neurological; Nystagmus, Pathologic; Randomized Controlled Trials as Topic; Topiramate; Trigeminal Nerve; Vertigo; Vestibule, Labyrinth; Visual Perception

Migraine is a common illness and migraine-related dizziness occurs in up to 3% of the population. Because the diagnosis is controversial and may be difficult, many patients go undiagnosed and untreated. This review summarizes current understanding of the taxonomy and diagnosis of vestibular migraine, the relation of vestibular migraine to labyrinthine disease, and the treatment of the condition in adults and children.. The categories of migraine accepted by the International Headache Society do not reflect the complex presentations of patients suspected of having vestibular migraine. In clinical practice and research, criteria are increasingly accepted that divide patients suspected of vestibular migraine into 'definite vestibular migraine' and 'probable vestibular migraine.' Because vertigo itself may trigger migraine, patients with vestibular migraine should be suspected of having vestibular end-organ disease until proven otherwise. Treatment remains controversial because of a notable lack of randomized controlled studies of vestibular migraine treatment.. For now, the best strategy for the treatment of suspected vestibular migraine patients is dietary/lifestyle modification, antinausea/antiemetics for acute vertigo, and preventive medication for patients who have continued disruptive symptoms. Patients with vestibular migraine should be monitored regularly for the development of latent audiovestibular end-organ disease.

Topics: Anticonvulsants; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Diet; Fructose; Humans; Life Style; Meniere Disease; Migraine Disorders; Topiramate; Vertigo

To assess the efficacy of topiramate in reducing both the frequency and the severity of vertigo and headache attacks in patients with migrainous vertigo and to compare 50 and 100 mg/day doses of the drug.. Thirty patients diagnosed as definite migrainous vertigo were recruited in the study. Vertigo and headache frequency was determined as the monthly number of attacks whereas severity was determined by visual analog scales measured in millimeters from 0 to 100. Patients were randomized to either 50 or 100 mg/day topiramate for 6 months. Vertigo and headache frequency and severity were evaluated at the end of the study period.. Number of mothly vertigo attacks decreased significantly in the overall group after treatment (median from 5.5 to 1; P < .01). The same was true for monthly headache attacks (median from 4 to 1; P < .01). A statically significant improvement in vertigo severity was noted (median from 80 to 20 mm; P < .01). Headache severity showed significant improvement as well (median from 60 to 30 mm; P < .01). No statistically significant difference between high- and low-dose groups was present regarding efficacy (P > .05). Four patients in the high-dose group discontinued treatment at the end of the first month because of adverse effects.. In the overall group, topiramate was found to be effective in reducing the frequency and the severity of vertigo and headache attacks. Both doses of the drug were equally efficacious. The 50 mg/day dose seems to be appropriate as higher adverse effects were noted when 100 mg/day was used.

Topics: Adolescent; Adult; Anticonvulsants; Diagnostic Imaging; Disability Evaluation; Dose-Response Relationship, Drug; Female; Fructose; Humans; Male; Middle Aged; Migraine Disorders; Neurologic Examination; Outcome Assessment, Health Care; Topiramate; Treatment Outcome; Vertigo; Young Adult

Five-three percent of the patients who suffer from migraine present severe incapacity and need rest in bed. If we add to this the incapacity produced by vertigo, then the quality of life of these patients is seriously affected. Migraine/Vertigo (MV) should be another criterion in the selection of preventive treatment even when other criteria are not fulfilled. Auditory symptoms may accompany MV. We treated 10 patients with Topiramate in an open trial, twice a day, with an average dose of 100 mg/day. The treatment period for these patients ranges between 6 and 16 months, with a mean of 9. As of today, all patients present no crisis. Regarding auditory symptoms, all the patients referred that they were stabilized. The effect began quickly, from the first month in most patients as it has been reported in other studies.

Topics: Adult; Aged; Female; Fructose; Hearing Disorders; Humans; Male; Middle Aged; Migraine Disorders; Neuroprotective Agents; Topiramate; Vertigo

To establish the concentration response of topiramate in patients with refractory focal epilepsy.. Sixty-five patients with more than eight seizures during an 8-week baseline were randomized to three prespecified plasma levels (low, 6 micromol/L [2 mg/L]; medium, 31 micromol/L [10.5 mg/L]; and high, 56 micromol/L [19 mg/L]). Topiramate treatment was titrated to one of the prespecified plasma levels during an 8-week titration period, followed by a 12-week observation period.. The overall median (25th to 75th percentile) reduction in seizures during the observation compared with baseline was 50% (9.5 to 90%). In the individual groups, the median reduction was as follows: low, 39% (13 to 70%); medium, 85% (41 to 96%); and high, 39% (2.0 to 81%). The primary outcome of the trial was the comparison of seizure reduction (Mann-Whitney U test) between the low and the medium group (p = 0.03). Comparisons between the other groups were as follows: medium vs high (p = 0.05) and low vs high (p = 0.81). Psychiatric adverse events and adverse events related to the CNS were the most frequently encountered. Most adverse events showed concentration response, particularly between low and medium levels.. Patients assigned to the medium plasma level (31 micromol/L [10.5 mg/L]) had the best seizure outcome. Patients in the medium and high groups experienced more adverse events than patients in the low group. Optimal treatment response is thus most likely found at plasma concentrations higher than 6 micromol/L (2 mg/L), but no further increase in efficacy seems to occur at concentrations above 31 micromol/L (10.5 mg/L).

Topics: Adult; Aged; Anticonvulsants; Dose-Response Relationship, Drug; Epilepsies, Partial; Female; Fructose; Humans; Male; Middle Aged; Safety; Seizures; Topiramate; Treatment Outcome; Vertigo

Episodic ataxia type 2 is an autosomal dominant channelopathy, caused by genetic variants in the voltage-dependent calcium channel a-1 subunit (CACNA1A), which is characterized by intermittent episodes of vertigo and ataxia. A slow progression of cerebellar signs is commonly observed in the course of the disease. Treatment with the carbonic anhydrase inhibitor acetazolamide is recommended.. We report the cases of two patients with EA-2 and migraine, linked to a novel CACNA1A mutation associated with disabling ictal and interictal disease, which did not respond to acetazolamide.. A 30-year-old woman and a 50-year-old man, who was a ski instructor, reported disabling episodes of rotatory vertigo and progressive interictal ataxia. In both cases, the disease progressed despite treatment with acetazolamide. The concomitant use of topiramate and 4-aminopyridine significantly reduced the frequency and severity of relapses and migraine and improved the interictal cerebellar progression in both cases.. We propose combined applications of topiramate and 4-aminopyridine in refractory cases and those with poor tolerance to acetazolamide and also in those with frequent associated migraine. The effectiveness of this combination of drugs for treating intermittent ataxic episodes and interictal signs in EA-2 has not been previously reported.

Topics: 4-Aminopyridine; Acetazolamide; Adult; Ataxia; Cerebellar Ataxia; Female; Humans; Male; Middle Aged; Migraine Disorders; Mutation; Nystagmus, Pathologic; Recurrence; Topiramate; Vertigo

Topics: Anxiety; Flunarizine; Humans; Migraine Disorders; Topiramate; Vertigo

Vestibular migraine (VM) consists of recurrent episodes of vestibular symptoms that are accompanied by migraine in at least 50% of the episodes. The criteria of the Bárány Society include two diagnostic categories: "actual" vestibular migraine and probable vestibular migraine. There is a wide range of drugs that can be prescribed for the prophylactic treatment of VM, but recommendations for the selection of the most appropriate drug are currently lacking.. To measure the extent to which the prophylactic treatment of VM reduces vestibular symptoms, headache and the number of crises depending on the diagnostic category of the Bárány Society and the drug used for prophylaxis.. This is a multicenter prospective study. Patients with VM who presented to any of the participating centers and who subsequently met the VM criteria were prescribed one of the following types of prophylaxis: acetazolamide, amitriptyline, flunarizine, propranolol or topiramate. Patients were called back for a follow-up visit 5 weeks later. This allowed the intensity of vestibular symptoms, headache and the number of crises before and during treatment to be compared.. 31 Patients met the inclusion criteria. During the treatment, all the measured variables decreased significantly. In a visual analogue scale, the intensity of vestibular symptoms decreased by 45.8 points, the intensity of headache decreased by 47.8 points and patients suffered from 15.6 less monthly crises compared to the period before the treatment. No significant between-group differences were found when patients were divided based on their diagnostic category or the choice of prophylaxis prescribed to them.. The treatment of VM produces a reduction of symptoms and crises with no significant differences based on patients' diagnostic categories or the choice of prophylaxis prescribed to them.

Topics: Acetazolamide; Amitriptyline; Analgesics; Central Nervous System Agents; Flunarizine; Humans; Migraine Disorders; Propranolol; Prospective Studies; Topiramate; Vertigo; Vestibular Diseases

Topics: Anticonvulsants; Female; Humans; Middle Aged; Migraine Disorders; Topiramate; Treatment Outcome; Vertigo; Vestibular Diseases

Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE-HS.. Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12-month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE-HS.. Seven hundred sixty-seven patients with a total of 3,249 AED trials were included. The highest 12-month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve-month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia.. Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE-HS.

Topics: Adolescent; Adult; Aged; Amines; Anticonvulsants; Ataxia; Benzodiazepines; Carbamazepine; Clobazam; Cyclohexanecarboxylic Acids; Databases, Factual; Diplopia; Dizziness; Epilepsy, Temporal Lobe; Female; Fructose; Gabapentin; gamma-Aminobutyric Acid; Hippocampus; Humans; Lamotrigine; Lethargy; Male; Middle Aged; Oxcarbazepine; Pregabalin; Retrospective Studies; Sclerosis; Topiramate; Treatment Outcome; Triazines; Valproic Acid; Vertigo; Vigabatrin; Vision Disorders; Young Adult

Topics: Adult; Anticonvulsants; Comorbidity; Cyclooxygenase Inhibitors; Diclofenac; Female; Fructose; Humans; Migraine with Aura; Mydriasis; Nausea; Topiramate; Treatment Outcome; Vertigo