Cognitive Effects of Low-dose Topiramate Compared with Oxcarbazepine in Epilepsy Patients

Sun-Young Kim, Ho-Won Lee, Doo-Kyo Jung, Chung-Kyu Suh, Sung-Pa Park, Sun-Young Kim, Ho-Won Lee, Doo-Kyo Jung, Chung-Kyu Suh, Sung-Pa Park

Abstract

Background and purpose: Low-dose topiramate (TPM) monotherapy has recently been found effective for seizure control in newly diagnosed epilepsy. In higher dosages, TPM has been associated with relatively high rates of adverse cognitive effects; similar side effects have been seen after rapid titration or polytherapy. However, its cognitive effects during low-dose monotherapy have not been established. We evaluated the cognitive effects of low-dose TPM compared with oxcarbazepine (OXC), a drug that does not appear to affect cognitive function.

Methods: Cognitive tests and subjective complaints of 30 patients with low-dose TPM monotherapy (50-200 mg/day) were retrospectively compared with those of 30 patients with OXC monotherapy at 1 year of medication. The two groups did not differ with respect to epilepsy-relevant variables, nor on baseline neuropsychological tests.

Results: The TPM group showed a significant difference in the performance of delayed word recall (P<0.05), backward digit span (P<0.01), and verbal fluency (P<0.05) compared with the OXC group. The TPM group showed worse performances of digit span and verbal fluency. The OXC group showed better performances of delayed word recall. The incidence of cognitive complaints was higher in the TPM group (50%) than in the OXC group (20%) (P<0.05). These cognitive effects shown in the TPM group were dose-related. The cognitive dysfunction was trivial with patients taking 50 mg/day TPM.

Conclusions: Even at low-dose, TPM has a negative effect on working memory and verbal fluency compared with OXC. It can be demonstrated at 1 year of treatment.

Keywords: Adverse effects; Cognition; Oxcarbazepine; Topiramate.

Figures

Figure 1
Figure 1
Comparison of the difference in mean cognitive scores before and after initiation of TPM medication among groups with different daily TPM dosages (50 mg, n=9; 75 mg, n=10; 100 mg, n=8; and 200 mg, n=3). A significant interaction effect on the digit span and verbal fluency tests is observed. A group assigned to take 50 mg/day TPM did not exhibit any significant change in scores on these cognitive tests compared with other groups. DSF; digit span forward, DSB; digit span backward, VF; verbal fluency. *P<0.05 (one-way ANOVA for independent samples).

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