家族易感性与托吡酯不常见认知不良反应的关系：机制探讨。
Familial vulnerability to an unusual cognitive adverse effect of topiramate: Discussion of mechanisms.
机构信息
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
出版信息
Indian J Psychiatry. 2010 Jul;52(3):260-3. doi: 10.4103/0019-5545.70986.
BACKGROUND
Some patients experience cognitive disturbances with topiramate.
CASE HISTORIES
A 19-year-old bipolar woman and her 46-year-old mother with paranoid personality disorder both used topiramate (25-50 mg/day) off-label for weight loss. Both women suffer from learning disorders, and both are excessively sensitive to the sedative adverse effects of psychotropic medications.
RESULTS
Within days of starting topiramate, the women began to exhibit troublesome word- and phrase-repetition and word substitution, both occurring only in their written expression. The symptoms were associated with mild sedation, persisted during two weeks of topiramate treatment, and remitted days after topiramate was withdrawn.
DISCUSSION
The presence of the learning disorders and the sensitivity to the sedative adverse effects of drugs may explain why cognitive adverse effects, known to occur with topiramate, developed at the low dose of 25-50 mg/day. The proclivity of topiramate to affect language functions and a possible familial vulnerability herein may explain why the women explained similar, language-specific symptoms. An investigation of topiramate-induced cognitive impairments in family members with epilepsy may throw light on the subject.
背景
一些患者在使用托吡酯时会出现认知障碍。
病例介绍
一位 19 岁的双相情感障碍女性和她 46 岁的患有偏执型人格障碍的母亲都因减肥而超说明书使用托吡酯（25-50mg/天）。两位女性都有学习障碍，并且对精神药物的镇静副作用都过于敏感。
结果
在开始使用托吡酯的几天内，这两位女性开始出现令人困扰的词语和短语重复以及词语替代，这些症状仅出现在她们的书面表达中。这些症状与轻度镇静有关，在托吡酯治疗的两周内持续存在，并在停用托吡酯几天后消失。
讨论
学习障碍的存在以及对药物镇静副作用的敏感性可能解释了为什么在低剂量 25-50mg/天的情况下会出现已知与托吡酯有关的认知不良反应。托吡酯影响语言功能的倾向以及其中可能存在的家族易感性可能解释了为什么这两位女性出现了类似的、特定于语言的症状。对癫痫患者的家族成员进行托吡酯引起的认知损伤的研究可能有助于阐明这个问题。
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