Evaluation of a Rapid Topiramate Titration Scheme for the Early Detection of Cognitive Side Effects.
Journal
CNS drugs
ISSN: 1179-1934
Titre abrégé: CNS Drugs
Pays: New Zealand
ID NLM: 9431220
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
accepted:
12
10
2022
pubmed:
3
11
2022
medline:
3
12
2022
entrez:
2
11
2022
Statut:
ppublish
Résumé
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. To evaluate a rapid TPM titration scheme for the early detection of adverse cognitive side effects. In this retrospective study, we assessed changes in objective cognitive performance (EpiTrack 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. 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.
Sections du résumé
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
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.
Identifiants
pubmed: 36322373
doi: 10.1007/s40263-022-00969-3
pii: 10.1007/s40263-022-00969-3
pmc: PMC9712312
doi:
Substances chimiques
Topiramate
0H73WJJ391
Anticonvulsants
0
Fructose
30237-26-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1325-1330Informations de copyright
© 2022. The Author(s).
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