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Topiramate and Psychiatric Adverse Events in
Patients with Epilepsy
Mula M, Trimble MR, Lhatoo SD, Sander JW
Posted: April 2004  
Epilepsia 2003;44:659-663

Purpose:   The aim of this study was to determine the prevalence of psychiatric adverse events in patients with epilepsy treated with topiramate. Classification, relation to topiramate dosing, and outcome were evaluated to identify a patient profile at risk of developing psychiatric adverse events.

Results:   Follow-up information was available for 431 patients. Psychiatric adverse events occurred in 103 patients. High starting dose and rapid titration schedule were relevant for the development of psychiatric adverse events. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic-atonic seizures were found to be significant risk factors. Low seizure frequency before starting topiramate and topiramate/lamotrigene coadministration had a protective effect for psychiatric adverse events.

Conclusions:   We found that psychiatric adverse events associated with topiramate were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.