Topiramate Related Cognitive Dysfunction during Migraine Prevention

J Korean Neurol Assoc > Volume 23(1); 2005 > Article

Journal of the Korean Neurological Association 2005;23(1): 55-61.

편두통 예방에서 토피라메이트와 연관된 인지기능장애

박성파, 정두교

경북대학교 의과대학 신경과학교실

Topiramate Related Cognitive Dysfunction during Migraine Prevention

Sung-Pa Park

Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea

Abstract

Background: Topiramate (TPM), a broad-spectrum antiepileptic drug, has recently been demonstrated to be effective as a monotherapeutic device for migraine prevention. We investigated the impact of TPM on cognition during migraine prevention.
Methods: Twenty-eight migraineurs were evaluated. They were instructed to take 25 mg of TPM per day, with 25 mg weekly increments to a maximum of 100 mg per day according to the therapeutic responsiveness. We assessed cognitive dysfunctions by spontaneous patient reports and several neuropsychological tests comparing the baseline and at 3 months during on-treatment. We also compared these tests to age, sex, education, clinical features of migraine, TPM dose, and global effectiveness.
Results: After 3 months of therapy, 21 patients undertook a follow-up neuropsychological test. Even though headache frequency, severity, and disability were significantly decreased in a follow-up period, there was a significant impairment in backward digit span (P=.006) and verbal fluency (P=.023). Thirteen patients (62%) showed an impaired backward digit span, and 11 patients (52%) exhibited an impaired verbal fluency. Five patients (24%) complained of symptoms associated with these impairments. Cognitive impairments were well correlated to the frequency of migraine attack, higher daily TPM dose, and global effectiveness. In six patients who showed the impairment of both items, TPM was withdrawn and their cognition was retested after 2 weeks. There was a significant improvement in these cognitive functions.
Conclusions: TPM appears to exert a dose-related, strong negative influence on working memory and verbal fluency during migraine prevention. It can be related to drug tolerability.KeyWords:Migraine, Prevention, Topiramate, Cognitive dysfunction, Neuropsychological test, Drug tolerability