Differential effects of topiramate in patients with traumatic brain injury and obesity - A case series

Department of Psychology, Bar Ilan University, Gan, Tel Aviv, Israel
Psychopharmacology (Impact Factor: 3.88). 07/2005; 179(4):838-45. DOI: 10.1007/s00213-004-2117-y
Source: PubMed
ABSTRACT
Topiramate is an antiepileptic drug known to have effects on weight. In order to use this as a tool to treat eating disorders, it is useful to examine whether these effects can be predicted in certain patients.
To report the effects of topiramate, initiated for the treatment of epilepsy, on top of ongoing treatment, on eating patterns and weight of 17 patients with traumatic brain injury (TBI) with post-traumatic epilepsy and weight gain of various etiologies.
Patients were followed up according to their usual treatment plan. Topiramate was added on top of current and stable treatment. Dose was titrated based on the patients' neurological status. Patients were asked to report side effects. No other changes were made.
Of the 17 patients included, one patient dropped out. Six patients with binge eating disorder (BED) demonstrated the most pronounced effects, with marked attenuation of binges and normalizing body mass index. Less noticeable were the effects in patients with mood disorders. Topiramate was ineffective in patients whose overweight was a side effect of their medication. Side effects were rated as mild and included somnolence, paresthesias, mild cognitive disturbances and some gastrointestinal disturbances.
In this report of the actual effects of topiramate in a clinical setting on weight and eating habits of 17 patients with TBI and obesity of various etiologies, topiramate seemed to be a safe intervention. Topiramate appeared to be differentially effective, with particular effects on primary pathological eating patterns.

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Available from: Shaul - Schreiber, Sep 30, 2014
Psychopharmacology (2005) 179: 838845
DOI 10.1007/s00213-004-2117-y
ORIGINAL INVESTIGATION
Ornah T. Dolberg
.
Gaby Barkai
.
Yigal Gross
.
Shaul Schreiber
Differential effects of topiramate in patients with traumatic brain
injury and obesitya case series
Received: 8 August 2004 / Accepted: 3 November 2004 / Published online: 24 December 2004
# Springer-Verlag 2004
Abstract Rationale: Topiramate is an antiepileptic drug
known to have effects on weight. In order to use this as a
tool to treat eating disorders, it is useful to examine
whether these effects can be predicted in certain patients.
Objectives: To report the effects of topiramate, initiated
for the treatment of epilepsy, on top of ongoing treat-
ment, on eating patterns and weight of 17 patients with
traumatic brain injury (TBI) with post-traumatic epilepsy
and weight gain of various etiologies. Methods: Patients
were followed up according to their usual treatment plan.
Topiramate was added on top of current and stable treat-
ment. Dose was titrated based on the patients neurological
status. Patients were asked to report side effects. No other
changes were made. Results: Of the 17 patients included,
one patient dropped out. Six patients with binge eating
disorder (BED) demonstrated the most pronounced effects,
with marked attenuation of binges and normalizing body
mass index. Less noticeable were the effects in patients
with mood disorders. Topiramate was ineffective in pa-
tients whose overweight was a side effect of their med-
ication. Side effects were rated as mild and included
somnolence, paresthesias, mild cognitive disturbances and
some gastrointestinal disturbances. Conclusions: In this
report of the actual effects of topiramate in a clinical setting
on weight and eating habits of 17 patients with TBI and
obesity of various etiologies, topiramate seemed to be a
safe intervention. Topiramate appeared to be differentially
effective, with particular effects on primary pathological
eating patterns.
Keywords Binge eating disorder
.
Obesity
.
PTSD
.
Post
Traumatic Stress Disorder
.
Topiramate
.
Traumatic brain
injury
.
TBI
.
Weight gain
.
Epilepsy
.
Side effects
Introduction
Topiramate is a structurally novel agent currently ap-
proved for the treatment of epilepsy (Wallace 2001).
Topiramate appears to have a broad spectrum of activity in
epilepsy (Chengappa et al. 2001a), and several possible
mechanisms have been identified. This medication has
been lately receiving a generous amount of attention in
the medical literature due to its weight loss promoting
characteristics. In addition, it is being examined for mi-
graine prophylaxis (Young et al. 2002), bipolar disorder
(Calabrese et al. 2001), eating disorders including anorex-
ia and binge eating disorder (BED) (Appolinario et al.
2002), and obesity (Bray et al. 2003) with or without a
concomitant psychiatric diagnosis. Apart from being
examined for its efficacy in treating the primary disorder,
it is concurrently judged for its effects on weight, and is
even being considered as an option in the management of
drug-induced obesity due to the use of atypical anti-
psychotics (Werneke et al. 2002) in patients with schizo-
phrenia or anxiety disorders (Van Ameringen et al. 2002).
Furthermore, topiramate seems to improve glycemic
control in patients with diabetes. Chengappa et al. (2001b)
report on three obese bipolar patients with type II diabetes
who received topiramate in combination with antipsychot-
ics and another mood stabilizer. These patients lost a
considerable amount of weight, and also achieved a sig-
nificant improvement in glycemic control.
O. T. Dolberg
.
G. Barkai
.
S. Schreiber
Department of Psychiatry, Tel Aviv Sourasky Medical Center and
The Department of Psychiatry, Sackler School of Medicine,
Tel Aviv University,
Tel Aviv, Israel
G. Barkai
.
Y. Gross
The Neuropsychiatric Unit for Treatment and Rehabilitation,
Yad Harutzim 14,
Tel Aviv, Israel
Y. Gross
Department of Psychology, Bar Ilan University,
Givat Shemuel, Israel
O. T. Dolberg (*)
Lundbeck Israel Ltd.,
P.O. Box 3088 Petach Tikva, 49130, Israel
e-mail: orna@lundbeck.com
Tel.: +972-3-9100100
Fax: +972-3-9100117
Page 1
As previously stated, topiramate is being examined for
its effectiveness as a primary psychiatric drugmost
notably as a mood stabilizer and for the treatment of binge
eating disorder. If determined to be efficacious in these
disorders and in light of its effect on weight, this might
prod topiramate to become a much prescribed treatment,
not only in epilepsy but also in mood disorders such as
bipolar affective disorder, and possibly even as an adjunct
therapy in depression (Carpenter et al. 2002). In addition,
topiramate might be added to the pharmacopoeia of eating
disorders, most prominently for binge eating disorder
(McElroy et al. 2003), and also for obesity and anorexia.
Whether due to the effects of medication, or as a result
of their primary psychiatric diagnosis, psychiatric patients
seem to suffer from obesity more than the average
population. Indeed, weight gain seems to be a prominent
reason for treatment discontinuation and drug non-com-
pliance among psychiatric patients (Weiden et al. 2003).
Therefore, a solution addressing this unmet need would be
most welcome.
In the neuropsychiatric unit, we address the needs of
patients with posttraumatic brain injuries. These patients
suffer from a combination of neurological disorders, psy-
chiatric disorders and frequently, orthopedic disabilities.
These result from combat wounds, road accidents, and
various intra-cranial injuries including hemorrhages, ische-
mic events, and tumors. These patients are notorious for
their unique response to medication, often requiring minute
dosages, or inversely, megadoses, long titration periods,
long discontinuation periods, paradoxical responses and
many other challenging pharmacological puzzles.
In this case series, we present the results of patients
treated with topiramate for post-traumatic epilepsy and the
effect that this medication had on their weight, in view of
their other medications and other psychiatric disorders.
Materials and methods
The series comprised 17 patients who were admitted to the
neuropsychiatric unit and treated with topiramate regard-
less of the etiology of their head trauma, the type of
epilepsy treated, and their psychiatric diagnoses or treat-
ment. All patients included had a BMI of at least 25, but
nearly all were significantly overweight and some ex-
tremely obese. All patients were initially treated with
topiramate for their epileptic disorder, following consulta-
tion with their neurologist, almost always after an EEG.
The decision whether to continue topiramate treatment was
based on the patients neurological condition and not on
weight or eating parameters. The patients were followed
up, as is usual for their condition, and the only change that
was made was weight assessment and questions pertaining
to their appetite and eating habits, which were emphasized
more than usual (although these are a routine part of the
patients follow-up program). Topiramate dosage was also
adjusted according to their neurological status. However,
doses were at times increased if there was a partial but
positive response regarding appetite suppression or decline
in binge frequency. This was done in coordination with the
patients neurologist, if needed. The treatment was not
initiated as an anti-obesity agent or an anti-binge agent, and
therefore although not a randomized or blinded study, there
were no expectations raised by this treatment among the
patients. Currently, these patients are still in treatment in
the neuropsychiatric unit, and are still on treatment with
topiramate, to the best of our knowledge.
As no intervention was performed that was specific to
the study, but rather treatment choices were based on
clinical parameters, and follow up was routine, the ethics
committee advising the neuropsychiatric unit deemed that
verbal consent is sufficient for participation in this study.
Results
The Neuropsychiatric Unit for Treatment and Rehabilita-
tion addresses the total needs of these patients including
but not limited to social, psychological, psychiatric, and
neurological and issues pertaining specifically to rehabil-
itation. The unit employs psychologists, social workers,
neuropsychiatrists, and rehabilitation specialists.
Seventeen patients were included in this study. The
characteristics of the patients are presented in Table 1. All
patients suffered from severe traumatic head injury, either
due to a road accident, a combat-related injury (such as a
bullet hole) or an ischemic or hemorrhagic insult such as
a ruptured aneurysm or a stroke. For example, patient
number 8 tried to commit suicide by shooting himself
in the head. Patient Number 17 suffered extensive head
trauma following a dive into an empty pool. Several pa-
tients were comatose for significant periods of time and
all were hospitalized in acute and then rehabilitation
wards for lengthy periods of time.
All patients suffer from neurological deficits and some
have, in addition, significant orthopedic disabilities. A
number of patients suffer from other consequences of their
trauma such as splenectomies, extensive facial plastic
reconstructive surgery, and artificial limbs. All patients use
a number of other medications including prescription and
over-the-counter (OTC) painkillers, anxiolytics, antipsy-
chotics, antidepressants, antiepileptics, anti-spastics, sleep
medication, and a myriad of other pharmacological agents
including drugs for the treatment of impotence, laxatives,
wakefulness promoters, artificial tears, antihypertensives
and basically any medication available. Among these
patients, it is not uncommon to see patients with a dozen
different drugs per day. However, all patients were several
years past their injury, the doses of their medication were
stable, and their psychiatric conditions were stable and no
changes were observed or made.
Prior to the initiation of treatment, the attending phy-
sician attempted to determine the central cause of the
weight gain in each individual patient. As these are com-
plex patients with a number of diagnoses and several
medications, this division is based on the clinicians long-
term acquaintance with the patients. Following this, weight
gain in six patients was attributed primarily to their eating
839
Page 2
Table 1 Demographic and clinical details of the patients included in the study
Sex Age Type of
trauma
Type of
epilepsy
Dose
(mg)
Neuro-psychiatric diagnosis Other medications Height (m) Weight (kg)
pre/post
BMI pre/post Side effects
1 F 40 MVA
1
Grand Mal 125 Organic major depressive disorder
(MDD) and binge eating disorder
(BED)
Mirtazapine
45 mg
1.65 75/65 27.5/23.9 Nausea
Paroxetine
40 mg
Valproate
2,000 mg
Clonazepam
6mg
2 F 21 MVA Grand Mal 250 Organic anxiety disorder Paroxetine 40 mg 1.66 80/77 29/27.9 Palpitations
Lorazepam 3 mg
Brotizolam
7.5 mg
3 F 44 MVA Partial 200 Organic MDD and BED Citalopram
40 mg
1.50 60/54 26.7/24 Nausea and
fullness
Mirtazapine
7.5 mg
Diazepam 4 mg
4 F 32 Ruptured
Aneurysm
Partial
Complex
150 Organic MDD and BED Reboxetine 8 mg 1.5 63/54 28/24 Somnolence
Valproate 600 mg
5 M 50 Combat Grand Mal 400 PTSD
2
and organic psychosis Olanzapine 20 mg 1.7 120/110 41.5/38
Valproate
1,200 mg
Carbamazepine
1,000 mg
Sertraline
100 mg
Clonazepam
4mg
Zopiclone 7.5 mg
6 M 48 Combat Grand Mal 300 PTSD and organic MDD Venlafaxine
225 mg
1.9 107/104 29.6/28.8 Somnolence
Carbamazepine
1,000 mg
Clonazepam
4mg
Etodolac 600 mg
840
Page 3
Sex Age Type of
trauma
Type of
epilepsy
Dose
(mg)
Neuro-psychiatric diagnosis Other medications Height (m) Weight (kg)
pre/post
BMI pre/post Side effects
7 F 35 Head trauma Partial 200 Organic borderline personality
disorder
Valproate
1,200 mg
1.68 76/80 27/28.4 Nausea
Lorazapam
2mg
Venlafaxine
150 mg
8 M 32 Suicide
attempt
Recent onset
Grand Mal
200 Organic delusional disorder Risperidone
2mg
1.75 76/76 25/25
Zopiclone
15 mg
9 F 38 MVA Unknown 250 MDD with atypical features Venlafaxine
225 mg
1.62 80/73 30.5/27.9
Eltroxin
150 mg
10 F 42 Stroke Grand Mal 800 Organic personality disorder Valproate
1,200 mg
1.62 80/82 30.5/31.3 Metallic taste
Risperidone
1mg
11 M 49 Combat Unknown 600 PTSD and MDD Citalopram
20 mg
1.75 87/80 28.4/26.1 Worsening of
nightmares
Mirtazapine
15 mg
Valproate
800 mg
Diazepam
10 mg
Flunitrazepam
2mg
12 F 51 Combat Partial 100 Post-traumatic dementia
and psychosis
Olanzapine
5mg
1.60 70/70 27.3/27.3
Clonazepam
0.5 mg
Sertraline
50 mg
Eltroxin
100 mg
Table 1 (continued)
841
Page 4
Sex Age Type of
trauma
Type of
epilepsy
Dose
(mg)
Neuro-psychiatric diagnosis Other medications Height (m) Weight (kg)
pre/post
BMI pre/post Side effects
13 F 30 MVA Grand Mal 200 Organic personality disorder Olanzapine
2.5 mg
1.6 65/? 25.4/? Withdrew
due to lack
of efficacyRofecoxib
25 mg
14 F 39 MVA Complex
Partial
500 Organic bipolar disorder
and BED
Lithium
1,200 mg
1.65 80/62 29.4/23 Nausea and
fullness
Olanzapine
7.5 mg
Fluoxetine
20 mg
Brotizolam
7.5 mg
15 F 45 MVA Grand Mal 400 Organic bipolar disorder
and BED
Lithium
1,500 mg
1.73 83/70 27.8/23.5 Difficulty in
finding
wordsValproate
1,200 mg
Mirtazapine
15 mg
Clonazepam
6mg
16 M 30 Combat Grand Mal 500 Organic bipolar disorder
and Pica
Valproate
800 mg
1.83 100/95 30/28.4
Lithium
1,500 mg
Olanzapine
7.5 mg
17 F 25 Head
Trauma
Partial 150 Organic personality disorder
and BED
Sertraline
150 mg
1.68 75/62 26.6/22
Etodolac
400 mg
Clonazepam
2mg
1
MVA=motor vehicle accident
2
PTSD=post traumatic stress disorder
Table 1 (continued)
842
Page 5
disorder; in five patients overweight was judged to be a
consequence of their mood disorders, mostly depression,
and in six patientsas drug (specifically antipsychotic)-
induced.
Thirteen patients were overweight prior to treatment
with topiramate (25<BMI<30). Three patients were obese
(30<BMI<40); one patient was extremely obese (BMI>40),
according to the guidelines of the National Heart, Lung and
Blood Institute (NHLBI 1998).
One patient withdrew after 2 weeks, claiming lack of
efficacy. The attending physician (OTD) believes non-
compliance was at the basis of the lack of effect. Of the 16
who continued, we perceived two patterns of response.
The first group, consisting of those with weight gain due
to a primary eating disorder, reported a significant sup-
pression of binges, and as a result experienced weight loss
that was both noticeable and numerically significant. The
second group, consisting of those with weight gain fol-
lowing a mood disorder, demonstrated a small response, if
at all; we included them with the patients with drug-in-
duced weight gain, who reported no change and indeed
remained practically at the same BMI.
The six patients with binge eating disorder (BED)
diagnosed according to the DSM-IV (patients number 1, 3,
4, 14, 15, 17) are all female. Three are diagnosed as
suffering from organic (i.e., post traumatic) major depres-
sive disorder (MDD), three as suffering from organic
bipolar disorder and one from an organic personality dis-
order. Their drug regimen is common to these conditions
including antidepressants, mood stabilizers, and benzo-
diazepines. In addition, all six suffer from BED that in five
started after the head injury (except patient number 17).
All of these six reported a significant reduction (greater
than 50%) and even a total remission of binges (in patients
3 and 4) that started shortly (within 2 weeks) after treat-
ment initiation and the effect did not wane throughout the
follow-up period. The therapeutic effect was so significant
and weight loss so pronounced that BMI normalized in all
six cases, with the highest current BMI being 24 (patients
3 and 4).
Except for patient number 17, the other five reported
side effects including nausea, somnolence, a feeling of
fullness and one patient reported difficulty in finding
words. Side effects were assessed as mild except in pa-
tient number 1 (whose nausea was assessed as moder-
ate), and in patient number 15 (who reported difficulty in
finding words), a dose reduction was suggested but the
patient refused. Six months into treatment, the patient re-
ported this side effect as occurring only occasionally.
In the five patients with various mood disorders and
weight gain attributed to thatthree were male and two
female. Two of the male patients also had post-traumatic
stress disorder (PTSD; patients 6 and 11). Patient number
16 was unusual in that he had an eating disorderpica
but this did not respond to topiramate treatment, unlike
BED. These patients had some response to topiramate
they each lost a small amount of weightbetween 3 and 7
kg. However, none of them achieved normal BMI and
patient number 11 complained of worsening of night-
mares; treatment was eventually discontinued and the
patient re-gained all the weight lost. A better explanation
for the palpitations reported by patient number 2 was
(eventually) her primary psychiatric disorder.
In the third group of patients, five patients with
psychotic disorders, topiramate seemed to have even less
effect. Patient number 5 lost some weight but since his
BMI was so high, this was hardly noticeable. Patient
number 7 gained 2 kg, as did patient number 10. Patients 8
and 12 showed no change at all. Patient number 10 re-
ported a metallic taste and we thought this might explain
the slight weight gain.
In summary, the strongest efficacy was noted in the
context with the diagnosis of an eating disorder, BED, in
this report. In other diagnoses, the effect was less pro-
nounced, and was particularly disappointing in patients
with obesity attributed to medication use. We found no
evident observable association with age, sex, or dose of
topiramate nor with baseline BMI.
Discussion
There are a number of reasons for the tremendous amount
of attention topiramate has been receiving in the last
couple of years in the literature for weight loss in the field
of psychiatry and neurology. First, obesity is on the rise
and has been declared the number one illness of the 21st
century in industrialized countries, so that we are now
hearing about obesity reaching epidemic proportions. In
the USA it is estimated that over half of the adult pop-
ulation is overweight (Birt 2003).
Second, weight gain is a frequent companion to the use
of particular psychotropic drugs, most commonly asso-
ciated with the use of antipsychotics. Certain atypical
antipsychotics seem to be implicated far more frequently
than other antipsychotics but significant weight gain can
also occur with the use of antidepressants, mood stabi-
lizers and others (Werneke et al. 2002).
This side effect needs to be addressed vigorously due to
its far-reaching, long-term implications. Weight gain is in
the top reasons for treatment discontinuation, especially
among women, and the long-term damages affect nearly
every body system including a steep rise in diabetes,
pancreatitis, various orthopedic disorders, cardiovascular
diseases, arthritis, gallstones, hernias, hypertension, can-
cer, sleep apnea, and several others (Birt 2003). Third,
weight gain can be a direct outcome of primary psychiatric
disorders, namely eating disorders. In binge eating disor-
der, 30% of patients participate in a weight loss program
and 70% of those individuals active in Overeaters Anon-
ymous display this disorder (Appolinario et al. 2002).
From the studies done today, it seems that topiramate plays
a particularly favorable role in this disorder with a unique
effect on normalizing bulimic behavior and a reduction
in binge frequency, and in a number of cases, remission
(Appolinario et al. 2002; McElroy et al. 2003).
In this case series of topiramate added to the ongoing
treatment regimen for neurological reasonsi.e., control
843
Page 6
of epilepsy in patients with traumatic brain injury (TBI)
and other neuropsychiatric complicationswe observed
two distinct patterns of response to topiramate. Patients
with medication-induced weight gain seemed to benefit
little from topiramate. They seemed to be less tolerant to
dose increase and weight loss appeared to be mild, at best.
This is in contrast to some case reports published in the
literature that showed a much more beneficial effect in
drug-induced weight gain. Lessig et al. (2001) report on
one case of topiramate reversing atypical antipsychotic
weight gain (quetiapine) in a patient with schizophrenia,
who lost 21 lb on 50 mg/day of topiramate. In another
report, a patient who gained 45 kg on clozapine lost 21 kg
on 125 mg/day of topiramate over a period of 5 months
(Dursun and Devarajan 2000). In a third report by Dursun
and Devarajan (2001), a woman with depression and drug-
induced weight gain was given 250 mg/day of topiramate
and her weight decreased from 89 to 59 kg.
Other case reports used topiramate for treatment of
bipolar disorder and found weight loss as an additional
benefit (Gordon and Price 1999; Erfurth and Kuhn 2000).
In one such case report, topiramate was so effective and
weight loss was so desirable that a bipolar patient with an
eating disorder abused the medication to the point of
extreme side effects (Colom et al. 2001).
In contrast to the relative paucity of these reports, there
is more evidence pertaining to the effectiveness of topira-
mate in eating disorders. In the study performed by Shapira
et al. (2000), 13 outpatients with binge-eating disorder
received naturalistic, open-label treatment with topiramate
in addition to ongoing treatment of their primary psychiatric
disorder. Dose of topiramate ranged from 100 mg to 1,400
mg. The patient receiving 1,400 mg of topiramate showed
a most dramatic response with their BMI falling from 43.4
to 26.7 (145.4 to 88.9 kg). This patient was diagnosed as
suffering from bipolar disorder and obsessivecompulsive
disorder in addition to her eating disorder. In another patient
with depression, treated with venlafaxine, 200 mg of topi-
ramate caused a reduction of BMI from 30.4 to 22.1 (loss
of 25 kg). Mean weight of patients decreased from 99 to
87 kg, and mean BMI decreased accordingly from 36.5 to
32.2. Side effects were reported to be mild and mostly
neurological and transient. McElroy et al. (2003) report on a
randomized, placebo-controlled trial of topiramate in BED
and obesity. This study lasted 14 weeks and used a flexible
dose of topiramate. Compared to placebo, topiramate-
treated patients (n=30) showed a significant reduction in
binges, BMI and weight. Dose range was 50600 mg. Side
effects included headaches and paresthesias and led to the
discontinuation of six patients on topiramate compared to
three on placebo.
The literature regarding the effects of topiramate on
weight loss is primarily based on topiramate as an an-
tiepileptic agent. The data shows that weight loss is typ-
ically observed in the first 3 months. Higher doses tend to
promote more weight loss than lower doses, women lose
more weight than men and the higher the baseline BMI,
the greater the weight loss. Similar findings have been
reported with topiramate as an anti-manic treatment, alone
or in conjunction with other mood stabilizers. The mech-
anism underlying topiramates effect on appetite, binges
and weight is not currently explained (Chengappa et al.
2001b).
In conclusion, among our patients we found two pat-
terns of response to topiramate. Those with drug-induced
weight gain seemed to benefit little from this intervention,
taking into consideration that weight gain was mild and
BMI was not in the extreme levels. On the other hand, those
with binge-induced weight gain seemed to receive substan-
tial benefit from this intervention, with significant weight
loss, reduction in binges and even total absence, and BMI
within normal range. The physical as well as the psycho-
logical benefits of such an effect cannot be underestimated.
This study is limited by a number of flaws. The small
number of patients with diverse and multiple diagnoses
and complicated treatments coupled with the lack of
randomization make our findings difficult to interpret.
However, we feel that the dichotomous response observed
among this group with the clear tendency of BED to be
responsive to this intervention regardless of any other
parameter, such as age, sex, baseline diagnosis, or baseline
BMI, deserved further pursuit, as the ill effects of obesity
are well documented.
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    • "Patients with TBI are also notorious for their unique response to medication, often requiring extremely large or conversely small doses, and long periods for titration and discontinuation . Paradoxical and other puzzling responses to medication remain to be clarified (Dolberg, Barkai, Gross, & Schreiber, 2005). Lack of consideration of various medication factors could result in over-or underpathologizing the individual and depriving them of opportunities for rehabilitation that could maximize their functional potential; this has, in fact, been reported (Strens, Mazibrada, Duncan, & Greenwood, 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: The purpose of this review is to educate and guide the actions of rehabilitation psychologists by providing a summary of the current literature on pharmacotherapies and treatment effectiveness for the chronic sequelae associated with severe traumatic brain injury (TBI). A number of medications are reviewed for use in treating deficits in arousal, cognition, function, and other problems associated with TBI. Findings for their use in this population are summarized. Cautions, limitations, and directions for future research are discussed. Conclusions: Pharmacological management of chronic symptoms of TBI is commonplace in rehabilitation practice. Clear clinical guidelines for the use of pharmacotherapy in TBI are lacking, however, because of the few conclusive findings regarding the effectiveness of any particular agent. Rehabilitation psychologists frequently encounter patients treated with numerous medications and, therefore, need to be aware of potential effects on cognitive and functional abilities. Additionally, rehabilitation psychologists should be aware of available and empirically supported pharmacotherapies as they are in a position to comprehensively assess the patient and provide requested consultation to the treating physician concerning the patient's need for and likelihood of benefiting from various pharmacological agents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Full-text · Article · Oct 2008 · Rehabilitation Psychology
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    [Show abstract] [Hide abstract] ABSTRACT: Topiramate (Topamax), an effective seizure disorder treatment, received additional FDA approval for prevention of migraine headaches in August 2004 and has gained attention for its off-label uses, including psychiatric and eating disorders, neuropalbic pain, and alcohol and drug dependency. Side effects of sedation, dizziness, ataxia, speech difficulty, nystagmus, paresthesia, and metabolic acidosis are described. The manufacturer reports that tolerance to the antiseizure properties does not develop. With its established efficacy for epilepsy treatment and its increased use for other disorders, topiramate-positive findings are more common in death-investigation and human-performance casework. To evaluate the role of topiramate, we reviewed all topiramate-positive cases from our laboratory between 1998 and 2004, which constituted 132 cases (63 death investigations, 68 suspected impaired drivers, and 1 sexual assault case). The subjects were predominantly female (69%) with a mean and median age of 42. Blood topiramate concentrations ranged from 1 to 180 mg/L (median 6.4 m/L, mean 8.4 mg/L), and 94% were positive for at least one additional drug. There was evidence of psychomotor impairment in some drivers with blood concentrations within the normal therapeutic range, and deaths attributed to topiramate alone occurred at concentrations as low as 50 mg/L.
    Full-text · Article · Nov 2006 · Journal of analytical toxicology
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    [Show abstract] [Hide abstract] ABSTRACT: Evidence is reviewed here which suggests that antiepileptic drugs (AEDs) may be effective for the treatment of impulsivity across a range of psychiatric disorders and for impulse control and cluster B personality disorders in particular. AEDs may be effective for the treatment of the brain circuitry related to impulsivity, by modulating GABA, glutamate, serotonin, and norepinephrine. It is suggested that interventions should be directed at the brain circuitry which modulates core symptoms like impulsivity that may be shared across disorders, rather than the disorder itself. In addition to these core symptom domains, clinicians should identify comorbid conditions and associated symptoms related to brain systems as they can also influence overall treatment response. The increasing experience of psychiatrists in treating impulse control disorders, cluster B personality disorders, and impulsivity across disorders should complement the knowledge obtained from research. This will lead to a better understanding of the brain mechanisms underlying impulsive symptom domains within disorders and to more targeted treatments with improved outcomes.
    Full-text · Article · Jul 2008 · Current Psychiatry Reviews
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