Huppertz H J, Quiske A, Schulze-Bonhage A
Sektion Prächirurgische Epilepsiediagnostik am Neurozentrum der Universität Freiburg, Breisacher Strasse 64, 79106 Freiburg.
Nervenarzt. 2001 Apr;72(4):275-80. doi: 10.1007/s001150050750.
In an open study, 37 epilepsy patients were investigated with regard to cognitive impairments in anticonvulsant add-on therapy with topiramate (TPM). In addition to a preexisting antiepileptic medication, TPM administration was started and increased by 25 mg/week. Cognitive side effects noted by the patient or doctor were assessed by a neuropsychological test battery. In 18/37 patients (49%), cognitive deficits consisting of impaired concentration, psychomotoric slowing, memory deficits, and dysphasia were observed. The adverse effects became apparent at dosages of 50-575 mg TPM/day (average 210 mg). In four patients, they were reversible after reducing the dose of TPM by 25-150 mg/day. In eight patients, the adverse effects led to withdrawal of TPM. In spite of slow titration, the present study showed a higher frequency of cognitive side effects under TPM than was previously reported. In some patients, these side effects led to substantial impairments in daily life and at work. For early recognition of cognitive impairments, neuropsychological baseline and follow-up investigations of verbal fluency, psychomotor processing speed, and verbal memory are recommended.
在一项开放性研究中，对37例癫痫患者在加用托吡酯（TPM）进行抗惊厥治疗时的认知障碍情况进行了调查。除了原有的抗癫痫药物治疗外，开始给予TPM治疗，并以每周25mg的剂量递增。通过一套神经心理学测试来评估患者或医生所记录的认知副作用。在37例患者中有18例（49%）出现了认知缺陷，包括注意力不集中、精神运动迟缓、记忆缺陷和言语困难。这些不良反应在TPM剂量为50 - 575mg/天（平均210mg）时显现出来。在4例患者中，将TPM剂量每天减少25 - 150mg后，不良反应可逆。在8例患者中，不良反应导致停用TPM。尽管采用了缓慢滴定法，但本研究显示TPM治疗下认知副作用的发生率高于先前报道。在一些患者中，这些副作用导致日常生活和工作出现严重障碍。为了早期识别认知障碍，建议进行神经心理学基线检查以及对言语流畅性、精神运动处理速度和言语记忆的随访调查。
