Institute of Legal Medicine, Innsbruck Medical University, Muellerstrasse 44, A-6020 Innsbruck, Austria.
Forensic Sci Int. 2010 Oct 10;202(1-3):e9-11. doi: 10.1016/j.forsciint.2010.04.035. Epub 2010 May 21.
Topiramate belongs to a new group of anticonvulsive drugs primarily applied in treatment of epilepsy and in preventive therapy of migraines. Topiramate is structurally unrelated to other antiepileptic drugs and acts by multiple neurostabilizing mechanisms. However, the pharmacology of topiramate appears to be complex and some of its pharmacodynamic actions still remain to be elucidated. This case report documents a fatal intoxication involving topiramate. A 41-year old woman with a known history of psychiatric disorder was found unresponsive by her husband. Resuscitation efforts did not succeed and the woman was pronounced dead at the intensive care unit four hours later. At the scene, drug packages of topiramate, citalopram and flunitrazepam were found. Autopsy including histological examination revealed morphological signs of an acute intoxication and shock. A comprehensive toxicological analysis with GC-MS was performed on the deceased's autopsy samples (femoral blood, bile, kidney, gastric content). The results revealed the presence of topiramate at a concentration of 49mg/L in the femoral blood sample, thus clearly exceeding the therapeutic range. Additionally, citalopram (0.85mg/L) and flunitrazepam in traces (<2μg/L) were detected in peripheral blood. Based on the autopsy findings and toxicological results, the cause of death was primarily attributed to an intoxication with topiramate in combination with citalopram.
托吡酯属于新型抗惊厥药物，主要用于治疗癫痫和偏头痛的预防性治疗。托吡酯与其他抗癫痫药物在结构上没有关系，通过多种神经稳定机制起作用。然而，托吡酯的药理学似乎很复杂，其一些药效作用仍有待阐明。本病例报告记录了一起涉及托吡酯的致命中毒事件。一名 41 岁女性，已知有精神病史，被丈夫发现失去反应。复苏努力没有成功，四小时后该女子在重症监护病房被宣布死亡。在现场发现了托吡酯、西酞普兰和氟硝西泮的药包。尸检包括组织学检查显示出急性中毒和休克的形态学迹象。对死者的尸检样本（股动脉血、胆汁、肾脏、胃内容物）进行了 GC-MS 全面毒理学分析。结果显示，股动脉血样中托吡酯的浓度为 49mg/L，明显超过治疗范围。此外，在外周血中还检测到西酞普兰（0.85mg/L）和氟硝西泮（<2μg/L）。根据尸检结果和毒理学结果，死亡的主要原因是托吡酯与西酞普兰联合中毒。
