Delpirou-Nouh Claire, Gelisse Philippe, Chanez Pascal, Carlander Bertrand
Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier Cedex 5, France.
Headache. 2007 Nov-Dec;47(10):1453-5. doi: 10.1111/j.1526-4610.2007.00921.x. Epub 2007 Sep 12.
Topiramate is effective in migraine headache prophylaxis. Pulmonary symptoms are rarely described as adverse effects. We report the case of a 42-year-old woman with migraine headaches who developed chronic shortness of breath while taking topiramate. Our patient experienced hand paresthesiae at a dose of 25 mg daily, and exercise induced dyspnea at doses above 50 mg daily; these symptoms worsened with increasing topiramate doses. Physical exam and chest x-ray were normal. Blood gas revealed a metabolic acidosis. Symptoms resolved after discontinuation of topiramate. Topiramate induces a lowering of blood carbon dioxide, which is usually asymptomatic. This is due to inhibition of carbonic anhydrase at the proximal renal tubule resulting in impaired proximal bicarbonate reabsorption. The decrease in CO(2) blood level facilitates the occurrence of metabolic acidosis. To our knowledge, this is the first case report of topiramate-induced dyspnea in a patient with migraine headaches.
托吡酯对偏头痛预防有效。肺部症状很少被描述为不良反应。我们报告一例42岁偏头痛女性患者，在服用托吡酯时出现慢性呼吸急促。我们的患者在每日剂量25毫克时出现手部感觉异常，每日剂量超过50毫克时出现运动诱发的呼吸困难；这些症状随着托吡酯剂量增加而加重。体格检查和胸部X光检查正常。血气分析显示代谢性酸中毒。停用托吡酯后症状缓解。托吡酯会导致血液二氧化碳水平降低，通常无症状。这是由于近端肾小管碳酸酐酶受抑制，导致近端碳酸氢盐重吸收受损。血液中二氧化碳水平降低促使代谢性酸中毒发生。据我们所知，这是首例关于托吡酯诱发偏头痛患者呼吸困难的病例报告。
