WORD FINDING DIFFICULTIES AND TOPIRAMATE
Abstract number :
2.357
Submission category :
Year :
2003
Submission ID :
2139
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Michael Trimble, Marco Mula, Josemir Sander, Pamela Thompson Clinical and Experimental Epilepsy, Institute of Neurology, London, United Kingdom
Topiramate is now an accepted antiepileptic drug with a favourable side effect profile. The main reported treatment emergent problems relate to CNS side effects, and word finding difficulties (WFD) have been noted in a sub-group of patients. It is unclear if any particular patients are susceptible to this, and if it is related to variables associated with the patients[apos] drug regimen or their epilepsy. We wished to explore these relationships in a large cohort of patients prescribed topiramate as add-on therapy.
Between October 1995 and December 2000, 431 patients were treated with Topiramate. Between 1995 and 1998 the starting dose was 50mg a day, with an escalation of 50mg every two weeks. From the second half of 1998 the schedule changed to starting doses and increments of 25mg. From the cohort, 31 patients with WFD were identified, and their data compared with a matched sample from the same cohort without any WFD.
Epilepsy (neurological and seizure related) and drug (titration rate, other prescriptions etc:) variables were assessed for all patients, and the groups compared using Chi squared analysis or ANOVA. A subsequent logistic regression analysis was used to assess the relationship of significant variables to WFD.
Of the total sample, 7.2% had WFD. 58% of these had only WFD, 42% also complained of other cognitive difficulties. In 71% the drug was stopped because of this problem. There was no relationship of WFD to titration schedule or starting dose.
22 of the 31 patients with WFD had a left sided EEG focus. In 31% it was a left anterior temporal EEG abnormality, and in 69% posterior. Regression analysis resulted in a reduced model that included the following variables: simple partial seizures, left temporal EEG abnormality.
The results of this study suggest that a sub-group of patients, especially those with a left sided focus for the epileptic discharge, are more likely to develop WFD with topiramate. This finding will be discussed in the light of the clinical importance and interest in this phenomenon.
[Supported by: The Raymond Way trust fund.]