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Petrusic I, Jovanovic V, Kovic V, Savic AM. P3 latency as a biomarker for the complexity of migraine with aura: Event-related potential study. Cephalalgia 2022; 42:1022-1030. [PMID: 35332814 DOI: 10.1177/03331024221090204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to compare the P3 component between patients who have migraines with aura and healthy subjects, and to compare different subtypes of migraine with aura relative to the complexity of migraine aura. METHODS Average Migraine Aura Complexity Score was calculated for each MwA patient. Visual oddball paradigm was used to elicit the P3 component. P3 amplitudes and latencies elicited from frequent and rare stimuli, as well as from difference wave, were compared with healthy subjects. Subsequently, subtypes of migraine with aura were compared and Average Migraine Aura Complexity Score was used to explore the connection between features of the P3 and complexity of migraine with aura. RESULTS 37 patients who have migraine with aura (16 with simple aura and 21 with complex aura) patients and 28 healthy subjects were studied. Patients who have migraine with aura had significantly prolonged latencies compared to healthy subjects (411 ± 39 ms vs 372 ± 34 ms, p < 0.001) relative to a rare condition. Patients who have complex aura significantly differs from patients who have simple aura (427 ± 34 ms vs 389 ± 35 ms, p = 0.004) and healthy subjects (372 ± 34 ms, p < 0.001) relative to P3 latency in a rare condition and the patients who have complex aura significantly differs from healthy subjects (442 ± 37 ms vs 394 ± 33 ms, p < 0.001) relative to P3 latency in difference wave. P3 latency from rare condition positively correlated with the Average Migraine Aura Complexity Score (p < 0.001). CONCLUSIONS Visual oddball paradigm, particularly rare stimuli, could serve as a potential new tool for deep profiling of different clinical complexities among patients who have migraine with aura. Also, the present pattern of P3 components provided new evidence for the cognitive dysfunctions in patients who have migraine with aura.
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Affiliation(s)
- Igor Petrusic
- University of Belgrade, Faculty of Physical Chemistry, Laboratory for Advanced Analysis of Neuroimages, Belgrade, Serbia
| | - Vojislav Jovanovic
- University of Belgrade, Faculty of Philosophy, Department of Psychology, Laboratory for Neurocognition and Applied Cognition, Belgrade, Serbia
| | - Vanja Kovic
- University of Belgrade, Faculty of Philosophy, Department of Psychology, Laboratory for Neurocognition and Applied Cognition, Belgrade, Serbia
| | - Andrej M Savic
- University of Belgrade, School of Electrical Engineering, Science and Research Centre, Belgrade, Serbia
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2
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Tippayachai P, Leelakanok N, Methaneethorn J. Significant predictors for topiramate pharmacokinetics: a systematic review of population pharmacokinetic studies. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patinee Tippayachai
- Department of Pharmacy Practice Faculty of Pharmaceutical Sciences Naresuan University Phitsanulok Thailand
| | - Nattawut Leelakanok
- Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences Burapha University Chonburi Thailand
| | - Janthima Methaneethorn
- Department of Pharmacy Practice Faculty of Pharmaceutical Sciences Naresuan University Phitsanulok Thailand
- Center of Excellence for Environmental Health and Toxicology Naresuan University Phitsanulok Thailand
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3
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Witt JA, Rademacher M, von Wrede R, Surges R, Helmstaedter C. Cognitive reawakening and improved quality of life achieved after discontinuing 16 years of anti-seizure treatment with topiramate. Neurocase 2022; 28:102-106. [PMID: 35102809 DOI: 10.1080/13554794.2022.2032187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 42-year-old female patient with epilepsy and a co-morbid migraine suffered from the severe cognitive side effects of topiramate (TPM) for more than 16 years with detrimental consequences for her daily functioning, career, and social interaction. Even a prodromal stage of dementia was suggested, giving rise to fears of developing a neurodegenerative disease. Recently, cognitive monitoring of attention and executive function before and after withdrawal of TPM revealed a significant recovery from the severe negative cognitive side effects of the long-standing and inefficacious antiseizure medication (ASM). Whereas the side effects were reversible after cessation, their consequences for the patient`s biography were permanent. A considerable increase in quality of life, however, was observed without TPM and family members were impressed by the improvements. This case illustrates the potentially severe consequences of negative cognitive side effects which affect daily functioning, career and social life, thus underscoring the importance of being knowledgeable of the potential cognitive risks when prescribing an ASM. Because cognitive side effects may not depend solely on ASM choice and drug load, but also on individual idiosyncratic intolerances, and patients might stay on their treatment for many years, cognitive monitoring is highly recommended.
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Affiliation(s)
| | - Michael Rademacher
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
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4
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Evaluation of a Rapid Topiramate Titration Scheme for the Early Detection of Cognitive Side Effects. CNS Drugs 2022; 36:1325-1330. [PMID: 36322373 PMCID: PMC9712312 DOI: 10.1007/s40263-022-00969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Topiramate (TPM) is effective for treating epilepsy, but executive dysfunction is a common side effect that could significantly affect everyday life. Additionally, previous studies have suggested that patients might be unaware of these changes. OBJECTIVE To evaluate a rapid TPM titration scheme for the early detection of adverse cognitive side effects. METHODS In this retrospective study, we assessed changes in objective cognitive performance (EpiTrack®) after rapidly titrating TPM (50 mg per day during an inpatient stay) in 49 epilepsy patients and compared those results with an outpatient control group that underwent the recommended standard titration (n = 23 with 25-50 mg per week). RESULTS Using Bayesian statistics, analyses revealed decisive evidence of a negative effect on cognitive performance when TPM was introduced (BF 31480000000) independent of the titration speed (BF 0.739). When using a fast titration rate, deficits in executive function increased from a baseline of 53.1 to 73.5% at follow-up, and 55.1% experienced a statistically significant intraindividual decline. When using the standard titration scheme, impairments increased from 52.2 to 65.2%, with an intraindividual deterioration found in 52.2% of the patients. CONCLUSION Physicians might be able to detect adverse cognitive side effects sooner in epilepsy patients if TPM is administered using a faster titration rate while applying repeated cognitive assessments within days. This approach might help prevent any unnoticed intolerance and eventual negative consequences for the patient. Therefore, we recommend monitoring early on for adverse changes instead of withholding a potentially effective treatment option because of anticipated side effects.
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5
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Soleimani Meigoni Z, Jabari F, Motaghinejad M, Motevalian M. Protective effects of forced exercise against topiramate-induced cognition impairment and enhancement of its antiepileptic activity: molecular and behavioral evidences. Int J Neurosci 2021; 132:1198-1209. [PMID: 33428483 DOI: 10.1080/00207454.2021.1873979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Propose/aim of study: Forced exercise can act as a neuroprotective factor and cognitive enhancer. The aim of the current study was to evaluate the effects of forced exercise on topiramate (TPM) induced cognitive impairment and also on TPM anti-seizure activity and neurodegeneration status after seizure.Material and method: Forty adult male rats were divided into four groups receiving normal saline, TPM (100 mg/kg), TPM in combination with forced exercise and forced exercise only respectively for 21 days. MWM test, and PTZ induced seizure were used and some oxidative, inflammatory and apoptotic biomarkers were measured for assessment of experimental animals.Results: Forced exercise in combination with TPM could abolish the TPM induced cognitive impairment and potentiates its anti-seizure activity. Also forced exercise in combination with TPM decreased malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β) and Bax protein, while caused increase in superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GR) activities after PTZ administration.Conclusion: It seems that forced exercise could act as an adjunct therapy with TPM for management of induced cognitive impairment and can also potentiate TPM antiepileptic and neuroprotective effects.
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Affiliation(s)
- Zahra Soleimani Meigoni
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jabari
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Motaghinejad
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Manijeh Motevalian
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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6
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Vallesi A. On the utility of the trail making test in migraine with and without aura: a meta-analysis. J Headache Pain 2020; 21:63. [PMID: 32493204 PMCID: PMC7271430 DOI: 10.1186/s10194-020-01137-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/27/2020] [Indexed: 01/18/2023] Open
Abstract
This meta-analytical review assesses the utility of the Trail Making Test (TMT), versions A and B, in detecting migraine-related cognitive deficits. A comprehensive literature search was performed in two electronic databases and other sources to obtain relevant studies administering TMT to migraine patients. Search terms included “migraine” and “Trail Making”. Only studies in which the TMT-A, TMT-B or both were administered to adult patients suffering from migraine with and without aura were included. All pooled meta-analyses were based on random effects models. A total of 14 studies for TMT-A and 15 for TMT-B met inclusion criteria and were subjected to meta-analyses. Results showed that performance is worse in migraine patients than in controls for both the TMT-A (Hedges’ g = −.28) and TMT-B (g = −.37), with no difference between migraine with and without aura. This study demonstrates the sensitivity of the TMT in detecting cognitive alterations in migraine. This test should be considered for inclusion in cognitive batteries assessing patients with migraine.
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Affiliation(s)
- Antonino Vallesi
- Department of Neuroscience & Padova Neuroscience Center, University of Padova, Via Giustiniani, 5, Padova, 35128, Italy. .,Brain Imaging and Neural Dynamics Research Group, IRCCS San Camillo Hospital, Venice, 30126, Italy.
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Marmura MJ, Kumpinsky AS. Refining the Benefit/Risk Profile of Anti-Epileptic Drugs in Headache Disorders. CNS Drugs 2018; 32:735-746. [PMID: 30073584 DOI: 10.1007/s40263-018-0555-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Anti-epileptic drugs are among the most effective drugs for migraine prophylaxis, and will likely continue to have a role even as new therapies emerge. Topiramate and valproate are effective for the preventive treatment of migraine, and other medications such as gabapentin or lamotrigine may have a role in the treatment of those with allodynia or frequent aura, respectively. Oxcarbazepine, carbamazepine, phenytoin, gabapentin, and others may alleviate pain in trigeminal neuralgia. While many anti-epileptic drugs can be effective in those with migraine or other headaches, most of these agents can potentially cause serious side effects. In particular, valproate, topiramate, carbamazepine, and phenytoin may lead to adverse outcomes for infants of exposed mothers. Valproate should not be given to women of childbearing potential for migraine prevention.
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Affiliation(s)
- Michael J Marmura
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut ST #200, Philadelphia, PA, 19107, USA.
| | - Aliza S Kumpinsky
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut ST #200, Philadelphia, PA, 19107, USA
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8
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Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:365-370. [PMID: 29932046 PMCID: PMC6039717 DOI: 10.3238/arztebl.2018.0365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. METHODS This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." RESULTS The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. CONCLUSION Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.
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Affiliation(s)
| | - Dagny Holle
- Department of Neurology and West German Headache Center, Essen
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen LEAD Graduate School & Research Network, University of Tübingen
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9
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Ahmed GF, Marino SE, Brundage RC, Pakhomov SVS, Leppik IE, Cloyd JC, Clark A, Birnbaum AK. Pharmacokinetic-pharmacodynamic modelling of intravenous and oral topiramate and its effect on phonemic fluency in adult healthy volunteers. Br J Clin Pharmacol 2016; 79:820-30. [PMID: 25403343 DOI: 10.1111/bcp.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 11/07/2014] [Indexed: 11/26/2022] Open
Abstract
AIMS The aim was to develop a quantitative approach that characterizes the magnitude of and variability in phonemic generative fluency scores as measured by the Controlled Oral Word Association (COWA) test in healthy volunteers after administration of an oral and a novel intravenous (IV) formulation of topiramate (TPM). METHODS Nonlinear mixed-effects modelling was used to describe the plasma TPM concentrations resulting from oral or IV administration. A pharmacokinetic-pharmacodynamic (PK-PD) model was developed sequentially to characterize the effect of TPM concentrations on COWA with different distributional assumptions. RESULTS Topiramate was rapidly absorbed, with a median time to maximal concentration of 1 h and an oral bioavailability of ~100%. Baseline COWA score increased by an average of 12% after the third administration on drug-free sessions. An exponential model described the decline of COWA scores, which decreased by 14.5% for each 1 mg l(-1) increase in TPM concentration. The COWA scores were described equally well by both continuous normal and Poisson distributions. CONCLUSIONS This analysis quantified the effect of TPM exposure on generative verbal fluency as measured by COWA. Repetitive administration of COWA resulted in a better performance, possibly due to a learning effect. The model predicts a 27% reduction in the COWA score at the average observed maximal plasma concentration after a 100 mg dose of TPM. The single-dose administration of relatively low TPM doses and narrow range of resultant concentrations in our study were limitations to investigating the PK-PD relationship at higher TPM exposures. Hence, the findings may not be readily generalized to the broader patient population.
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Affiliation(s)
- Ghada F Ahmed
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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10
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Lim CN, Birnbaum AK, Brundage RC, Leppik IE, Cloyd JC, Clark A, Marino SE. Pharmacokinetic-Pharmacodynamic Modeling of Intravenous and Oral Topiramate and Its Effect on the Symbol-Digit Modalities Test in Adult Healthy Volunteers. J Clin Pharmacol 2015; 56:714-22. [PMID: 26395889 DOI: 10.1002/jcph.646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022]
Abstract
A sequential pharmacokinetic-pharmacodynamic (PK-PD) modeling approach was used to quantify the effects of a single dose of topiramate (100 or 200 mg) on working memory, attention, and psychomotor speed as measured by the Symbol-Digit Modalities Test (SDMT). Established on data pooled from 3 randomized, crossover studies in healthy subjects (19-55 years of age), using both oral and a novel stable-labeled intravenous (IV) formulation of topiramate, an inhibitory Emax model was found to characterize the topiramate concentration-SDMT score relationship well. At the EC50 of 2.85 μg/mL, this topiramate plasma concentration value was estimated to be associated with a 25.5% reduction of SDMT score relative to baseline. Age was an important determinant of the baseline SDMT score, with an estimated decrease of 1.13% in baseline SDMT score with every year of age. Moreover, this approach enabled the quantification of the practice effect observed with repeated administration of the neuropsychological test over shorter testing intervals than have previously been reported in the literature. The finding of a significant effect following a single dose of topiramate in the range widely used to treat migraine and epilepsy needs to be evaluated in a broader patient population undergoing chronic treatment, as the narrow range of resultant concentrations limits the generalizability of the findings.
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Affiliation(s)
- Chay Ngee Lim
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Richard C Brundage
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Ilo E Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - James C Cloyd
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Center for Orphan Drug Research, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Annie Clark
- Upsher Smith Laboratories, Minneapolis, MN, USA
| | - Susan E Marino
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Center for Clinical and Cognitive Neuropharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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11
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Romigi A, Femia EA, Fattore C, Vitrani G, Di Gennaro G, Franco V. Zonisamide in the management of epilepsy in the elderly. Clin Interv Aging 2015; 10:931-7. [PMID: 26089654 PMCID: PMC4467644 DOI: 10.2147/cia.s50819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Zonisamide (ZNS), a second-generation antiepileptic drug, indicated as add-on treatment of focal epilepsy, has been recently approved as monotherapy for the treatment of partial seizures in adults affected by newly diagnosed epilepsy in Europe. Evidence on the efficacy and tolerability of antiepileptic drugs in the elderly is still lacking as these patients are frequently excluded from clinical trials. Here, a comprehensive overview of available data regarding the use of ZNS in the treatment of epilepsy in elderly people is provided. In a pooled analysis conducted in patients aged ≥65 years, no new/unexpected safety findings have emerged. Few data from uncontrolled investigations suggest that ZNS may be effective and well tolerated when administered as monotherapy or adjunctive antiepileptic treatment in the elderly. However, evidence from these observational studies is less than satisfactory, and randomized controlled trials focused on these patients are still needed.
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Affiliation(s)
- Andrea Romigi
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Pozzilli (IS), Italy
- Neurophysiopathology Department, University of Rome Tor Vergata, Rome, Italy
| | - Eti A Femia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Cinzia Fattore
- Clinical Trial Centre & Antiepileptic Drugs, C. Mondino National Neurological Institute, Pavia, Italy
| | - Giuseppe Vitrani
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Valentina Franco
- Clinical Trial Centre & Antiepileptic Drugs, C. Mondino National Neurological Institute, Pavia, Italy
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12
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Beltramini GC, Cendes F, Yasuda CL. The effects of antiepileptic drugs on cognitive functional magnetic resonance imaging. Quant Imaging Med Surg 2015; 5:238-46. [PMID: 25853082 DOI: 10.3978/j.issn.2223-4292.2015.01.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/22/2015] [Indexed: 12/15/2022]
Abstract
The cognitive dysfunction caused by antiepileptic drugs (AEDs) has been extensively described, although the mechanisms underlying such collateral effects are still poorly understood. The combination of functional magnetic resonance imaging (fMRI) studies with pharmacological intervention (pharmaco-MRI or ph-MRI) offers the opportunity to investigate the effect of drugs such as AEDs on brain activity, including cognitive tasks. Here we review the studies that investigated the effects of AEDs [topiramate (TPM), lamotrigine (LMT), carbamazepine (CBZ), pregabalin (PGB), valproate (VPA) and levetiracetam (LEV)] on cognitive fMRI tasks. Despite the scarcity of fMRI studies focusing on the impact of AEDs on cognitive task, the results of recent work have provided important information about specific drug-related changes of brain function.
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Affiliation(s)
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Campinas, SP, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Campinas, SP, Brazil
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13
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Rass O, Umbricht A, Bigelow GE, Strain EC, Johnson MW, Mintzer MZ. Topiramate impairs cognitive function in methadone-maintained individuals with concurrent cocaine dependence. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:237-46. [PMID: 25365653 PMCID: PMC4388752 DOI: 10.1037/adb0000027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Topiramate is being investigated as a potential pharmacotherapy for the treatment of addictive disorders. However, its cognitive side effects raise concerns about its use, especially in populations with cognitive impairment, such as persons with chronic substance use disorders. This study investigated topiramate's cognitive effects in individuals dually dependent on cocaine and opioids as part of a double-blind, randomized, controlled trial of topiramate for cocaine dependence treatment. After 5 weeks of stabilization on daily oral methadone (M = 96 mg), participants were randomized to topiramate (n = 18) or placebo (n = 22). Cognitive testing took place at 2 time points: study weeks 4 through 5 to assess baseline performance and 10 to 13 weeks later to assess performance during stable dosing (300 mg topiramate or placebo). All participants were maintained on methadone at both testing times, and testing occurred 2 hours after the daily methadone plus topiramate/placebo administration. The topiramate and placebo groups did not differ on sex, level of education, premorbid intelligence, methadone dose, or illicit drug use. Topiramate slowed psychomotor and information processing speed, worsened divided attention, reduced n-back working memory accuracy, and increased the false alarm rate in recognition memory. Topiramate had no effects on visual processing, other measures of psychomotor function, risk-taking, self-control, Sternberg working memory, free recall, and metamemory. These findings indicate that topiramate may cause cognitive impairment in this population. This effect may limit its acceptability and use as a treatment in individuals with chronic opioid and cocaine use disorders, among whom preexisting cognitive impairments are common. (PsycINFO Database Record
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Affiliation(s)
- Olga Rass
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Annie Umbricht
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - George E Bigelow
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Matthew W Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Miriam Z Mintzer
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Abstract
INTRODUCTION Migraine is a very common medical disorder characterized by attacks of moderate-severe headache, nausea and disability. Topiramate is an effective, popular prophylactic migraine treatment, which is approved for use in adults and adolescents. Due to its multiple mechanisms of action, topiramate has multiple potential safety issues, including systemic and CNS adverse events, which may complicate therapy. AREAS COVERED This review evaluates common adverse events as seen in the pivotal trials of topiramate for migraine as well as those observed in postmarketing studies. These include weight loss, metabolic acidosis, renal calculi, acute angle closure glaucoma, visual distortions and cognitive slowing. Topiramate use during pregnancy is associated with an increased risk of cleft lip. This review highlights both common and unusual safety issues associated with topiramate use, including important drug interactions and a comparison with other migraine prophylactic agents. EXPERT OPINION Topiramate is highly effective in migraine prophylaxis but clinicians using the drug need to be aware of the potential for bothersome or serious adverse events. When treating with topiramate, use a slow titration to the goal dose of 100 mg or the lowest dose, which helps prevent migraine.
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Affiliation(s)
- Michael J Marmura
- Thomas Jefferson University, Jefferson Headache Center, Department of Neurology , 900 Walnut Street, Suite 200, PA 19107 , USA +1 215 955 2243 ; +1 215 955 2060 ;
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15
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Effects of the anticonvulsant topiramate on language abilities in people with epilepsy: a cross-sectional study. Ir J Psychol Med 2014; 27:179-183. [DOI: 10.1017/s0790966700001488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AbstractObjectives: The aim of this study was to investigate the effects of topiramate (TPM) on cognitive function, specifically language, in patients with epilepsy, and to determine whether a specifically designed neuropsychological test battery can show such effects.Method: Twenty patients taking TPM, 25 epilepsy controls (taking medication other than TPM) and 25 healthy controls were recruited. We used a specific neuropsychological battery, including measures of visual and verbal memory, attention, fluency and comprehension. Separate one way between group ANOVAs were performed for each neuropsychological measure.Results: Bonferroni comparisons revealed that the TPM group performed significantly worse than epilepsy controls on digits forward (p<0.001), digits backward (p<0.05), controlled oral word association (COWA) (p<0.05) and token test (p<0.05). The TPM group also needed more multiple choice cues in the Boston naming test (p<0.05).Conclusions: The present study indicates that 15% of the sample tested had impaired language abilities and raises interesting questions regarding the nature of this effect. Furthermore, we have identified some short neuropsychological tasks that can be performed in routine clinical situations that can reliably identify patients who have negative linguistic effects of TPM.
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Sommer BR, Mitchell EL, Wroolie TE. Topiramate: Effects on cognition in patients with epilepsy, migraine headache and obesity. Ther Adv Neurol Disord 2013; 6:211-27. [PMID: 23858325 DOI: 10.1177/1756285613481257] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This paper reviews the clinical implications of topiramate (TPM)-induced cognitive deficits in patients with epilepsy, migraine headache, obesity, and in normal populations, followed by reviews of the literature describing the reversal of such deficits upon medication discontinuation. It also discusses animal investigations of TPM's role of neuroprotection in brain injury. TPM's most intolerable adverse effects (AEs) are on verbal fluency and reaction time, resulting in high discontinuation rates in patients taking it for epilepsy and migraine headache. However, because TPM is so effective in the treatment of epilepsy and migraine headache, its use is expected to continue. There appears to be greater tolerance of TPM's cognitive AEs when it is used in the treatment of obesity, perhaps because of the lower doses required. Research attempting to predict the populations most vulnerable to the cognitive effects caused by TPM is ongoing. Studies suggest that one such population may include patients with a past psychiatric history. Slow titration and administration of the lowest possible doses may decrease risk of cognitive deficits.
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Affiliation(s)
- Barbara R Sommer
- Stanford University School of Medicine, Department of Psychiatry, 401 Quarry Road, Stanford, CA 94305-5723, USA
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Di W, Shi X, Zhu Y, Tao Y, Qi W, Luo N, Xiao Z, Yi C, Miao J, Zhang A, Zhang X, Fang Y. Overuse of paracetamol caffeine aspirin powders affects cerebral glucose metabolism in chronic migraine patients. Eur J Neurol 2012; 20:655-62. [PMID: 23114018 DOI: 10.1111/ene.12018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 09/18/2012] [Indexed: 01/22/2023]
Affiliation(s)
- W. Di
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - X. Shi
- Department of Nuclear Medicine; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Y. Zhu
- Zhongshan Ophthalmic Center; Sun Yat-sen University; Guangzhou China
| | - Y. Tao
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - W. Qi
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - N. Luo
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Z. Xiao
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - C. Yi
- Department of Nuclear Medicine; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - J. Miao
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - A. Zhang
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - X. Zhang
- Department of Nuclear Medicine; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Y. Fang
- Department of Neurology; the First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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Witt JA, Elger CE, Helmstaedter C. Impaired verbal fluency under topiramate--evidence for synergistic negative effects of epilepsy, topiramate, and polytherapy. Eur J Neurol 2012; 20:130-7. [PMID: 22827489 DOI: 10.1111/j.1468-1331.2012.03814.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/12/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Treatment with topiramate (TPM) is known to negatively affect executive functions and verbal fluency in particular. However, judgments of cognitive side effects under TPM rarely consider clinical conditions and possible effects of epilepsy, treatment, and drug load. METHODS This retrospective cross-sectional study in large cohorts of patients with epilepsy evaluated the impact of TPM mono- and polytherapy on verbal fluency. To isolate TPM-induced effects from those of epilepsy and antiepileptic medication in general, verbal fluency under TPM (N = 421) was compared to the performance of a matched sample of patients with an antiepileptic medication other than TPM (N = 351), untreated patients (N = 108), and healthy controls (N = 100). RESULTS Impaired verbal fluency performance was seen in 77% of the patients treated with TPM. Compared to healthy controls, verbal fluency in untreated patients was reduced by 22%, under monotherapy without TPM by 31% and under TPM monotherapy by 45%. With and without TPM, verbal fluency performance linearly decreased with each additional drug in polytherapy. On each level, performance under TPM was 21-28% worse than in the respective condition without TPM. Unimpaired performance under TPM was primarily associated with lower dose, higher education, and a later onset of epilepsy. CONCLUSIONS The majority of patients under TPM shows reduced verbal fluency. However, when taking the cumulative negative effects of epilepsy, and the concomitant drug regimen into account, TPM is associated with a 21-28% poorer performance as compared with other drugs. Additionally, the data indicate an impact of dose and reserve capacity on the occurrence of impairments.
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Affiliation(s)
- J-A Witt
- Department of Epileptology, University Clinic of Bonn, Bonn, Germany.
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Marino S, Pakhomov S, Han S, Anderson K, Ding M, Eberly L, Loring D, Hawkins-Taylor C, Rarick J, Leppik I, Cibula J, Birnbaum A. The effect of topiramate plasma concentration on linguistic behavior, verbal recall and working memory. Epilepsy Behav 2012; 24:365-72. [PMID: 22658432 PMCID: PMC3804073 DOI: 10.1016/j.yebeh.2012.04.120] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
This is the first study of the effect of topiramate on linguistic behavior and verbal recall using a computational linguistics system for automated language and speech analysis to detect and quantify drug-induced changes in speech recorded during discourse-level tasks. Healthy volunteers were administered a single, 100-mg oral dose of topiramate in two double-blind, randomized, placebo-controlled, crossover studies. Subjects' topiramate plasma levels ranged from 0.23 to 2.81 μg/mL. We found a significant association between topiramate levels and impairment on measures of verbal fluency elicited during a picture description task, correct number of words recalled on a paragraph recall test, and reaction time recorded during a working memory task. Using the tools of clinical pharmacology and computational linguistics, we elucidated the relationship between the determinants of a drug's disposition as reflected in plasma concentrations and their impact on cognitive functioning as reflected in spoken language discourse.
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Affiliation(s)
- S.E. Marino
- Center for Clinical and Cognitive Neuropharmacology, University of Minnesota,Experimental and Clinical Pharmacology, University of Minnesota
| | - S.V.S. Pakhomov
- Center for Clinical and Cognitive Neuropharmacology, University of Minnesota,Pharmaceutical Care and Health Systems, University of Minnesota
| | - S. Han
- The J. Crayton Pruitt Family Dept of Biomedical Engineering, University of Florida, Gainesville FL
| | - K.L. Anderson
- The J. Crayton Pruitt Family Dept of Biomedical Engineering, University of Florida, Gainesville FL
| | - M. Ding
- The J. Crayton Pruitt Family Dept of Biomedical Engineering, University of Florida, Gainesville FL
| | - L.E. Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis MN
| | - D.W. Loring
- Dept of Neurology, Emory University, Atlanta GA
| | | | - J.O. Rarick
- Experimental and Clinical Pharmacology, University of Minnesota
| | - I.E. Leppik
- Experimental and Clinical Pharmacology, University of Minnesota
| | - J.E. Cibula
- Dept of Neurology, University of Florida, Gainesville FL
| | - A.K. Birnbaum
- Center for Clinical and Cognitive Neuropharmacology, University of Minnesota,Experimental and Clinical Pharmacology, University of Minnesota
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20
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de Araújo CM, Barbosa IG, Lemos SMA, Domingues RB, Teixeira AL. Cognitive impairment in migraine: A systematic review. Dement Neuropsychol 2012; 6:74-79. [PMID: 29213777 PMCID: PMC5619244 DOI: 10.1590/s1980-57642012dn06020002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with migraine often report cognitive complaints, especially regarding
attention and memory.
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Affiliation(s)
- Caroline Martins de Araújo
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Izabela Guimarães Barbosa
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Stela Maris Aguiar Lemos
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Renan Barros Domingues
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Antonio Lucio Teixeira
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
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Likhitsathian S, Saengcharnchai P, Uttawichai K, Yingwiwattanapong J, Wittayanookulluk A, Srisurapanont M. Cognitive changes in topiramate-treated patients with alcoholism: a 12-week prospective study in patients recently detoxified. Psychiatry Clin Neurosci 2012; 66:235-41. [PMID: 22443246 DOI: 10.1111/j.1440-1819.2012.02326.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to determine the 12-week cognitive changes in topiramate-treated patients recently detoxified from alcohol. METHODS Participants were inpatients with DSM-IV alcohol dependence. All of them were discharged within 14 days after the initiation of topiramate treatment. The topiramate dose range was 50-300 mg/day. The Montreal Cognitive Assessment (MoCA) was used on day 0, day 29, day 57, and day 85. Differences of the MoCA total and seven subtest scores among four time-points were compared. RESULTS Thirty-eight participants (36 men and two women) had a mean ± SD age of 43.1 ± 8.6 years old. At enrollment, they were abstinent for a mean ± SD of 11.5 ± 5.3 days. Five, one, and three patients dropped out of the study on day 29, day 57, and day 85, respectively. On day 85, the mean ± SD dose of topiramate was 253.1 ± 60.8 mg/day. Alcohol consumption decreased drastically during follow up. At each time-point, 75%-80% of the participants were continuous abstainers. The mean ± SD MoCA total, language subtest, and delayed recall subtest scores increased significantly from day 0 to day 85, from 22.0 ± 4.7 to 24.7 ± 3.4 (P < 0.01), from 1.1 ± 1.0 to 1.3 ± 1.0 (P = 0.03), and from 2.7 ± 1.7 to 4.1 ± 1.0 (P < 0.01), respectively. CONCLUSION Topiramate-treated patients recently detoxified from alcohol usually have an improvement of their cognitive function, especially in the language and delayed recall domains. This phenomenon may be caused by the greater influence of cognitive recovery associated with decreased drinking as compared with topiramate-induced cognitive impairment.
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Affiliation(s)
- Surinporn Likhitsathian
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University Chiang Mai Drug Dependence Treatment Center, Chiang Mai, Thailand
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Sinclair LI, Dineen PT, Malizia AL. Modulation of ion channels in clinical psychopharmacology: adults and younger people. Expert Rev Clin Pharmacol 2012; 3:397-416. [PMID: 22111619 DOI: 10.1586/ecp.10.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This review focuses on the use of Na(+), Ca(2+) and Cl(-) channel modulators in psychiatric disease. Drugs that modulate ion channels have been used in psychiatry for more than a century, and in this review we critically evaluate clinical research that reports the therapeutic effects of drugs acting on GABA(A), voltage-gated Na(+) and voltage-gated Ca(2+) channels in pediatric and adult patients. As in other fields, the evidence underpinning the use of medicines in younger people is far less robust than for adults. In addition, we discuss some current developments and highlight clinical disorders in which current molecules could be further tested. Notable success stories, such as benzodiazepines (in sleep and anxiety disorders) and antiepileptics (in bipolar disorder), have been the result of serendipitous discoveries or refinements of serendipitous discoveries, as in all other major treatments in psychiatry. Genomic, high-throughput screening and molecular pharmacology discoveries may, however, guide further developments in the future. This could include increased research in promising targets that have been perceived as commercially risky, such as selective α-subunit GABA(A) receptors.
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Affiliation(s)
- Lindsey I Sinclair
- Psychopharmacology Unit, Department of Community Based Medicine, University of Bristol, Bristol, UK
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Jokeit H, Reed V. Cognitive effects of topiramate in migraine patients aged 12-17 years. Pediatr Neurol 2011; 44:396; author reply 396-7. [PMID: 21481754 DOI: 10.1016/j.pediatrneurol.2011.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2011] [Indexed: 11/26/2022]
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Neurology in the European Journal of Neurology. Eur J Neurol 2010. [DOI: 10.1111/j.1468-1331.2010.03248.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hynes CA, Mar RA. A case study of long-term cognitive and social functioning following a right temporal lobectomy in infancy. Neurocase 2008; 15:37-46. [PMID: 19090414 DOI: 10.1080/13554790802603679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the rare case of an adult patient, FS, who had a right anterior temporal lobe resection during infancy to treat intractable epilepsy, and underwent a cognitive evaluation 19 years later. Given the paucity of literature on long-term outcomes for infants who receive neurosurgery for epilepsy, this case provides valuable information for both clinicians and patients. What little literature exists on infant and child surgical outcomes for epilepsy suggests a variable course, with several areas of possible cognitive and social difficulty. FS's assessment at the age of 21 revealed only mild difficulties with memory, sequencing, and visual imagery, and spared intellectual functioning, working memory, problem-solving and social cognition, along with a high level of socioeconomic functioning. Thus, the case of FS suggests that neurosurgery during infancy is not necessarily associated with large-scale cognitive impairment, and furthermore, that high levels of functioning both educationally and vocationally are possible after surgical treatment of epilepsy in infancy.
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Affiliation(s)
- Catherine A Hynes
- School of Psychology, The University of Queensland, St Lucia, Australia.
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