Article type: Review Article
Article
title: Topiramate-associated movement disorder: case series and literature review
Journal: Clinical
Neuropharmacology
Year: 2020
Authors: Jamir Pitton Rissardo, Ana Letícia Fornari
Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Background:
Topiramate (TPM) is a fructose derivative, which was originally developed as an
antiepileptic. In this context, movement disorders (MDs) are possible adverse
events secondary to TPM. Case reports: Two patients (cases 1 and 2) developed
myoclonus, and the other 2 had restless leg syndrome (RLS, cases 3 and 4). The
mean age of the individuals (3 female patients) was 45.75 ± 21.28 years. All
the individuals had a negative family history for movement and psychiatry
disorders. Topiramate was started at 25 mg with a gradual increase of 25 mg
every week. The mean time of onset and recovery of the MD were 1.37 ± 1.10 and
1.02 ± 0.77 months, respectively. The mean TPM dose was 87.5 ± 47.87 mg.
Individual 1 presented with upper and lower limb jerks; individual 2 only with
upper limb involvement. Individuals 3 and 4 experienced insomnia and nocturnal
leg discomfort during inactivity with an urge to move the legs, which they
denied having previously; the RLS symptoms occurred within approximately 1 to 3
hours of TPM evening dose. On neurological examination, no tremor or
bradykinesia was observed; deep tendon reflexes, sensory examination, and
strength were normal and preserved. Laboratory tests, neuroimaging, and
electromyography were within normal. Topiramate was discontinued in all of the
subjects. Full recovery was obtained in all cases. Conclusions: To the authors'
knowledge, there are 6 cases of myoclonus, 5 RLS, 2 dystonia, 1 dyskinesia, and
1 periodic limb MD. The best management is probably the discontinuation of TPM,
but in RLS patients, the addition of a dopaminergic agonist can be beneficial.
Keywords: Topiramate, review, movement
disorder, drug-induced.
Full text available at:
DOI
10.1097/WNF.0000000000000395
Citation
Rissardo JP, Caprara AL.
Topiramate-associated movement disorder: case series and literature review. Clin Neuropharmacol 2020;43:116-120.