Additional sanogenetic effect of topiramate in the treatment of epilepsy in women of childbearing age

A relationship of epilepsy and a used antiepileptic drug (AED) with the menstrual cycle, overweight, and reproductive disorders in women has been studied in recent years. In this connection,  topiramate engages attention as one of the AEDs that contribute to  weight loss, but not gain.

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

Patients and methods. An analysis was made in a group of 58 patients of fertile age (18–35 years) with a long history of focal epilepsy (FE) (n = 44) or idiopathic generalized epilepsy (IGE) (n =  14) who received mainly combined therapy with 2 AEDs. Different  degrees of overweight was observed in 82.8% of the patients;  51.7% had one or another menstrual cycle disorders; however, the  women had been followed up by a gynecologist in exceptional  cases. Switching 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 in 78.6% of those with IGE.

Results. 29.3% of the patients receiving dual therapy, the second medication of which was topiramate, were noted to have lost weight not only if those had a 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).

Discussion. The use of topiramate that has a wide spectrum of action in different types of seizures and forms of epilepsy in patients with a long history of the disease could achieve seizure remission in  59.1% of the patients with FE and in 78.6% of those with IGE for a  period of more than 12 months. One-third of all the cases were  observed to have lost 3–13 kg (median, 6 kg) of weight during  monotherapy or dual therapy with topiramate. The latter resulted in  the normalization of menstrual function in 5 patients, which was  8.6% of all the patients and 16.7% of those with menstrual cycle problems.

Conclusion. In addition to a significant improvement in the disease course, the use of topiramate in monotherapy or dual therapy for FE or IGE can contribute to the normalization of body weight and the  menstrual cycle. The authors draw the attention of epileptologists to  the need to monitor menstrual function in women with epilepsy.

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