Therapy for epilepsy in women: Additional sanogenetic effect caused by the intake of topiramate

Objective: to investigate the efficacy/tolerability of topiramate in reproductive-aged women.

Subjects and methods. A group of 58 patients in fertile age (18–35 years) with a long history of focal (n=44) or idiopathic generalized (n=14) epilepsy (FE and IGE) who received mainly combined therapy with 2 antiepileptic drugs (AEDs) was analyzed. 82.8% of the patients were overweight; 51.7% had one or other menstrual cycle disorders; however, the women had been followed up by a gynecologist in exceptional cases.

Results. Switch from one of the parent AEDs to topiramate or its incorporation into a treatment regimen as an additional drug substantially improved the course of the disease: remission at 12 months was achieved in 59.1% of the patients with FE and 78.6% of those with IGE. 29.3% of the patients receiving dual therapy, the second medication of which was topiramate, were observed to have lost weight not only if those had high baseline body mass index (BMI), but also if those had normal BMI at baseline. 8.6% of all the patients and 16.7% of those with menstrual cycle disorder achieved normalization of menstrual function. Topiramate was discontinued only in 1 (1.7%) patient because of critical weight loss (BMI<15). In addition to substantial improvement, topiramate used in mono- or dual therapy for FE and IGE may normalize weight and a menstrual cycle. Menstrual function is indicated to be monitored in epileptic women.

1. Власов ПН, Петрухин ВА, Наумова ГИ. Сопутствующая патология со стороны женской половой сферы и беременность при эпилепсии. Качественная клиническая практика. 2005;(3):52-60. [Vlasov PN, Petrukhin VA, Naumova GI. Concomitant diseases of female genitalia and pregnancy in epilepsy. Kachestvennaya klinicheskaya praktika. 2005;(3):52-60. (In Russ.)].

2. Карлов ВА. Эпилепсия у детей и взрослых, женщин и мужчин. Москва: Медицина; 2010. 720 с. [Karlov VA. Epilepsiya u detei i vzroslykh, zhenshchin i muzhchin [Epilepsy in children and adults, women and men]. Moscow: Meditsina; 2010. 720 p.]

3. Жидкова И, Карлов В, Адамян Л. Эпилепсия и репродуктивное здоровье женщины. Клинические, патогенетические и терапевтические аспекты. Москва: Palmarium Academic Publishing; 2012. 278 c. [Zhidkova I, Karlov V, Adamyan L. Epilepsiya i reproduktivnoe zdorov'e zhenshchiny. Klinicheskie, patogeneticheskie i terapevticheskie aspekty [Epilepsy and women's reproductive health. Clinical, pathogenetic and therapeutic aspects]. Moscow: Palmarium Academic Publishing; 2012. 278 p.]

4. Власов ПН, Филатова НВ, Наумова ГИ. Эпилепсия у женщин, гормональный аспект. В кн. Современная эпилептология. Под ред. Е.И. Гусева и А.Б. Гехт. Москва: АПКиППРО; 2011. С. 269-76. [Vlasov PN, Filatova NV, Naumova GI. Epilepsy in women, hormonal aspect. In: Sovremennaya epileptologiya [Modern epileptology]. Gusev EI, Gekht AB, editors. Moscow: APKiPPRO; 2011. P. 269-76.]

5. Harden C, Sanjeev VT, Tomson T. Epilepsy in Women. John Wiley & Sons; 2013. 232 p.

6. Doose DR, Wang SS, Padmanabham M, et al. Effect of topiramate or carbamazepine on the pharmacokinetics of an oral contraceptive containing norethindrone and ethynil estradiol in healthy obese and nonobese female subjects. Epilepsia. 2003 Apr;44(4):540-9.

7. Morrow J. The XX factor. Treating women with anti-epileptic drugs. National services of health improvement. Nuffield press Ltd; 2007. 80 p.

8. Cross JH, Shorvon S, Perucca E, et al. Topiramate. The treatment of Epilepsy. Second edition. Blackwell science; 2004. P. 535-45.

9. Зенков ЛР. Осложнения противоэпилептической фармакотерапии. Русский медицинский журнал. 2005;(5):41-6. [Zenkov LR. Complications of antiepileptic drug therapy. Russkii meditsinskii zhurnal. 2005;(5):41-6. (In Russ.)].

10. Tassinarri C, Michelucci R, Chauvel P, et al. Double blind placebo controlled trial of topiramate (600 mg daily) for the treatment of refractory partial epilepsy. Epilepsia. 1996 Aug;37(8):763-8.

11. Reife R, Pledger G, Wu SC. Topiramate as add-on therapy: pooled analysis of randomized controlled trials in adults. Epilepsia. 2000;41 Suppl 1:S66-71.

12. Мухин КЮ, Глухова ЛЮ, Петрухин АС и др. Топамакс при монотерапии эпилепсии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2004;(8):35-40. [Mukhin KYu, Glukhova LYu, Petrukhin AS, et al. Topamax in monotherapy of epilepsy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2004;(8):35-40. (In Russ.)].

13. Трифонова ОЕ, Белоусова ЕД. Побочные действия топирамата. Клиническая эпилептология. 2009;(1):17-22. [Trifonova OE, Belousova ED. Side effects of topiramat. Klinicheskaya epileptologiya. 2009;(1):17-22. (In Russ.)].

14. Холин АА, Заваденко НН, Ильина ЕС и др. Возрастзависимая эффективность и безопасность применения топирамата у пациентов с различными формам эпилепсии. Эпилепсия и пароксизмальные состояния. 2013;5(3): 34-41. [Kholin AA, Zavadenko NN, Il'ina ES, et al. Age-dependent efficacy and safety of application of topiramat in patients with various forms of epilepsy. Epilepsiya i paroksizmal'nye sostoyaniya. 2013;5(3): 34-41. (In Russ.)].

15. Asconape JJ. Some common issues in the use of antiepileptic drugs. Semin Neurol. 2002 Mar;22(1):27-39.

16. Luef H. Female issues in epilepsy: A critical review. Epilepsy Behav. 2009 May;15(1):78-82. doi: 10.1016/j.yebeh.2009.02.023. Epub 2009 Feb 21.