• Clinical and Experimental Pediatrics
• /
• v.53 no.4
• /
• pp.554-559
• /
• 2010

Purpose : The purpose of this study was to evaluate whether the therapeutic effects of topiramate differ according to the types of migraine. Methods : We recruited 38 children and adolescents with migraine who had been treated with topiramate. The effect of topiramate was evaluated on the basis of the change in the frequency of migraine attacks after treatment. Results : Among patients having migraine with aura, 85.7% showed complete recovery, 1 (7.1%) showed partial recovery, and 1 did not show any recovery. Among patients having migraine without aura, 47.1% showed complete recovery, 29.4 % showed partial recovery, and 23.5% showed no recovery. Among patients suspected with migraine, 1 (20%) showed complete recovery, 1 (20%) showed partial recovery, and 3 (60%) showed no recovery. Conclusion : Our results indicated that topiramate exhibited excellent therapeutic effects for migraine accompanied with aura, and it was effective in migraine without aura. However, the effect of topiramate in patients suspected with migraine was uncertain.

• Korean Journal of Clinical Pharmacy
• /
• v.17 no.1
• /
• pp.6-12
• /
• 2007

The clinical investigations above suggest that topiramate may be an effective agent in the treatment of BED or BN by reducing binging/purging episodes, improving the HRQOL, and decreasing weight. The case report and case series also support these findings. However, there are several limitations in the above studies and cases. All these had relatively small sample size, and two of them were only 10-week-period studies. Optimal duration of treatment with topiramate in patients with BED or BN is unknown. As most clinicians treat the patient with BED or BN for 6 to 12 months and then reassess, at least 6 months period is needed to show its efficacy. One of studies included only women in the patient group. In the case series, all patients had severe comorbid mood disorders such as major depression and bipolar disorder besides BN. Therefore, notwithstanding its clinical usefulness, additional researches are needed to define the role and the benefits of topiramate in the treatment of BED or BN more thoroughly.

• Journal of Life Science
• /
• v.15 no.3 s.70
• /
• pp.505-512
• /
• 2005

Excitotoxicity and epileptogenesis have often been associated with glutamate receptor activation. Accumulating evidences indicates that topiramate (TPM), an antiepileptic drug with multiple mechanisms of action has neuroprotective activity. We explored the neuroprotective effect of TPM on the status epilepticus (SE)-induced hippocampal neuronal death. After development of SE by kainite injection (15 mg/Kg), rats were treated with TPM (10mg/kg) for 1 week. The neuronal death was detected by Apop tag in situ detection kit, and the expression levels of glutamate receptors were semi-quantitatively analyzed by immunoblot. Kainate-induced SE caused a significant neuronal death and cell loss in CAI and CA3 regions of hippocampus at 1 week. However, treatment of TPM for 1 week after SE markedly reduced hippocampal neuronal death. The expression of N-methyl-D-aspartate (NMDA) receptor subunit 1, was increased by SE, but was not affected by 1 week treatment of TPM. The expressions of NMDA receptor subunit 2a and 2b were not changed by either SE or TPM. As for ${\alpha}-amino-3-hydroxy-5-methyl-4-isoxazole-propionate$ (AMPA) glutamate receptors (GluR), kainate-induced SE markedly up-regulated GluR1 expression but down-regulated GluR2 expression, leading to increased formation of $Ca^{2+}$ permeable GluR2- lacking AMPA receptors. TPM administration for 1 week attenuated SE-induced expression of both the up-regulation of GluR1 and down-regulation of GluR2, reversing the ratio of GluR1/GluR2 to the control value. In conclusion, TPM protects neuronal cell death against glutamate induced excitotoxicity in kainate-induced SE model, supporting the potential of TPM as a neuroprotective agent.

• Clinical and Experimental Pediatrics
• /
• v.60 no.7
• /
• pp.227-231
• /
• 2017

Purpose: This study aimed to verify the safety of low-dose topiramate on language development in pediatric patients with migraine. Methods: Thirty newly diagnosed pediatric patients with migraine who needed topiramate were enrolled and assessed twice with standard language tests, including the Test of Language Problem Solving Abilities (TOPs), Receptive and Expressive Vocabulary Test, Urimal Test of Articulation and Phonology, and computerized speech laboratory analysis. Data were collected before treatment, and topiramate as monotherapy was sustained for at least 3 months. The mean follow-up period was $4.3{\pm}2.7months$. The mean topiramate dosage was 0.9 mg/kg/day. Results: The patient's mean age was $144.1{\pm}42.3months$ (male-to-female ratio, 9:21). The values of all the language parameters of the TOPs were not changed significantly after the topiramate treatment as follows: Determine cause, from $15.0{\pm}4.4$ to $15.4{\pm}4.8$ (P>0.05); making inference, from $17.6{\pm}5.6$ to $17.5{\pm}6.6$ (P>0.05); predicting, from $11.5{\pm}4.5$ to $12.3{\pm}4.0$ (P>0.05); and total TOPs score, from $44.1{\pm}13.4$ to $45.3{\pm}13.6$ (P>0.05). The total mean length of utterance in words during the test decreased from $44.1{\pm}13.4$ to $45.3{\pm}13.6$ (P<0.05). The Receptive and Expressive Vocabulary Test results decreased from $97.7{\pm}22.1$ to $96.3{\pm}19.9months$, and from $81.8{\pm}23.4$ to $82.3{\pm}25.4months$, respectively (P>0.05). In the articulation and phonology validation in both groups, speech pitch and energy were not significant, and all the vowel test results showed no other significant values. Conclusion: No significant difference was found in the language-speaking ability between the patients; however, the number of vocabularies used decreased. Therefore, topiramate should be used cautiously for children with migraine.

• Journal of Pharmaceutical Investigation
• /
• v.38 no.4
• /
• pp.277-282
• /
• 2008

The purpose of the present study was to evaluate the bioequivalence of two topiramate tablets, Topamax tablet (Janssen Korea. Co., Ltd., Seoul, Korea, reference drug) and Topamin tablet (Myungmoon Pharm. Co., Ltd., Seoul, Korea, test drug), according to the guidelines of Korea Food and Drug Administration (KFDA). Twenty-four healthy male Korean volunteers received one tablet at the dose of 100 mg topiramate in a $2{\times}2$ crossover study. There were two-weeks washout period between the doses. Plasma concentrations of topiramate were monitored by an LC-MS/MS for over a period of 96 hr after administration. $AUC_t$ (the area under the plasma concentration-time curve from time zero to 96 hr) was calculated by the linear trapezoidal rule method. $C_{max}$ (maximum plasma drug concentration) and $T_{max}$ (time to reach $C_{max}$) were compiled from the plasma concentration-time data. Analysis of variance (ANOVA) was carried out using logarithmically transformed $AUC_t$ and $C_{max}$. The 90% confidence intervals of the $AUC_t$, ratio and the $C_{max}$ ratio for Topamin/Topamax were $\log0.88{\sim}\log1.02$ and $\log0.87{\sim}\log1.03$, respectively. These values were within the acceptable bioequivalence intervals of $\log0.80{\sim}\log1.25$. Taken together, our study demonstrated the bioequivalence of Topamax and Topamin with respect to the rate and extent of absorption.

• Clinical and Experimental Pediatrics
• /
• v.54 no.9
• /
• pp.380-384
• /
• 2011

Purpose: To investigate the efficacy of topiramate monotherapy in West syndrome prospectively. Methods: The study population included 28 patients (15 male and 13 female children aged 2 to 18 months) diagnosed with West syndrome. After a 2-week baseline period for documentation of the frequency of spasms, topiramate was initiated at 2 mg/kg/day. The dose was increased by 2 mg/kg every week to a maximum of 12 mg/kg/day. Clinical assessment was based on the parents' report and a neurological examination every 2 weeks for the first 2 months of treatment. The baseline electroencephalograms (EEGs) were compared with the post-treatment EEGs at 2 weeks and 1 month. Results: West syndrome was considered to be cryptogenic in 7 of the 28 patients and symptomatic in 21 patients. After treatment, 11 patients (39%) became spasm-free, 6 (21%) had more than 50% spasms-reduction, 3 (11%) showed less than 50% reduction, and 8 (29%) did not respond. The effective daily dose for achieving more than 50% reduction in spasm frequency, including becoming spasm-free, was found to be $5.8{\pm}1.1$ mg/kg/day. Nine patients (32%) showed complete disappearance of spasms and hypsarrhythmia, and 11 (39%) showed improved EEG results. Despite adverse events (4 instances of irritability, 3 of drowsiness, and 1 of decreased feeding), no patients discontinued the medication. Conclusion: Topiramate monotherapy seems to be effective and well tolerated as a first line therapy for West syndrome and is not associated with serious adverse effects.

• Clinical and Experimental Pediatrics
• /
• v.50 no.4
• /
• pp.386-389
• /
• 2007

Cyclic vomiting syndrome (CVS) is a paroxysmal, recurrent vomiting disorder of unknown pathophysiology and target organ. It has been hypothesized that CVS shares the same mechanism as migraine. We describe here a 5-year-old boy with CVS characterized by episodic vomiting attacks. These recurrent vomiting episodes began at 3 years of age, occurred every month and lasted for 5 days at a time. At the time of admission, no abnormal physical or neurological findings were observed and laboratory findings, including brain MRI and endoscopic examination, revealed nothing specific. The vomiting episodes were self-limited but recurrent and severely interrupted his daily life. When this patient was treated with topiramate, he showed a marked increase of symptom-free periods.

• Clinical and Experimental Pediatrics
• /
• v.49 no.11
• /
• pp.1180-1185
• /
• 2006

Purpose : The aims of this study were to verify the incidence of hypohidrosis and to determine the predictive value of noninvasive indicator test ($Neurocheck^{TM}$) for sweating after administration of topiramate in newly diagnosed pediatric epileptic patients. Methods : A total of 46 epileptic patients (22 boys; 24 girls) on topiramate treatment were evaluated in this study at the Department of Pediatrics, Chonbuk National University Hospital, from October 2004 to July 2005. We measured sweating functions using a noninvasive sweating test ($Neurocheck^{TM}$) before topiramate medication, and after 3 months when topiramate reached its target dosage. We performed a direct questionnaire survey for the hypohidrosis related symptoms during topiramate treatment. Results : The mean age was $7.8{\pm}3.2year$. The mean dosage of topiramate was $4.5{\pm}0.8mg/kg/day$. Among the patients, there were 40 complex partial seizures, one simple partial seizure, two partial seizures with secondarily generalization, two generalized seizures, and one Lennox-Gastaut syndrome case. Of the 46 epileptic patients, 17 patients (37.0 percent) experienced hypohidrosis and hypohidrosis related symptoms, 12 (26.1 percent) had facial flushing, four (8.7 percent) had heat intolerance, one (2.2 percent) had lethargy, but no one had anhidrosis. Among the 17 patients, the mild group numbered 12 and the severe group totalled five. Hypohidrosis by $Neurocheck^{TM}$ was diagnosed in 16 patients. The overall measures of agreement between $Neurocheck^{TM}$ and the survey was 76.5 percent. The specificity of this test was 89.7 percent. Patients who showed a time delay after medication, especially over 3 minutes, were seen only in the severe group. Conclusion : $Neurocheck^{TM}$ could be clinically useful to detect and predict topiramate induced hypohidrosis in pediatric epileptic patients. We recommend that patients who show a delay over 3 minutes in $Neurocheck^{TM}$ test after topiramate initiation should be monitored for hypohydrosis.

• Speech Sciences
• /
• v.14 no.4
• /
• pp.221-232
• /
• 2007

Topiramate (TPM) is a new antiepileptic drug characterized by a clinical effective reduction in seizure frequency and it represents a useful drug effective in a wide range of epileptic patients. Known side effects are represented by weight loss, hypohidrosis, anorexia, sedation, nephrolithiasis, cognitive complaints and language disorders. This study is to examine acoustic characteristics of patients with TPM. 15 patients were assessed through a Computerized Speech Lab (CSL) applied before the beginning of therapy with TPM and 3 months after medication had been stabilized. Tests had been chosen to assess voice onset time (VOT), total duration (TD), vowel formants, loudness, pitch, speaking rate, and articulation patterns. We compared the data from patients and healthy volunteers. The statistical analysis of the results did not show changes in acoustic tests, except for TD which was increased. The increase of the TD is evaluated as a deterioration of fluency. Our results suggest that patients with TPM did not experience acoustic speech changes except that fluency was declined. Unlike previous studies, the medication of TPM has nothing to do with speech problems in patients with epilepsy.

• Archives of Obesity and Metabolism
• /
• v.1 no.1
• /
• pp.43-45
• /
• 2022

Intensive lifestyle modifications and anti-obesity medications are essential for obesity treatment. Antiobesity medications should be selected according to the patient's comorbidities, symptoms, and preferences. This case report describes the treatment of a morbidly obese patient with a history of depression, who complained of tingling and numbness after total thyroidectomy for papillary thyroid cancer. Very low-dose controlled-release phentermine/topiramate was prescribed and intensive lifestyle modifications were encouraged. As a result, the patient effectively lost weight and reached a near-normal weight without adverse drug effects. This implies that even an off-label anti-obesity medication low dose may be better for some patients, and the most important factor in obesity treatment is patient-tailored treatment.