Cognitive reawakening and improved quality of life achieved after discontinuing 16 years of anti-seizure treatment with topiramate

ABSTRACT

A 42-year-old female patient with epilepsy and a co-morbid migraine suffered from the severe cognitive side effects of topiramate (TPM) for more than 16 years with detrimental consequences for her daily functioning, career, and social interaction. Even a prodromal stage of dementia was suggested, giving rise to fears of developing a neurodegenerative disease. Recently, cognitive monitoring of attention and executive function before and after withdrawal of TPM revealed a significant recovery from the severe negative cognitive side effects of the long-standing and inefficacious antiseizure medication (ASM). Whereas the side effects were reversible after cessation, their consequences for the patient`s biography were permanent. A considerable increase in quality of life, however, was observed without TPM and family members were impressed by the improvements. This case illustrates the potentially severe consequences of negative cognitive side effects which affect daily functioning, career and social life, thus underscoring the importance of being knowledgeable of the potential cognitive risks when prescribing an ASM. Because cognitive side effects may not depend solely on ASM choice and drug load, but also on individual idiosyncratic intolerances, and patients might stay on their treatment for many years, cognitive monitoring is highly recommended.

KEYWORDS:

• Epilepsy
• neuropsychology
• side effects
• cognitive decline
• cognition
• quality of life
• antiepileptic drugs
• antiseizure drugs
• withdrawal
• dementia

Acknowledgments

We would like to thank Karen Wörmann for proof-reading and language editing.

Disclosure statement

The authors declare no conflict of interest with regard to the current work.

Dr. Witt reports personal fees from Eisai, outside the submitted work; Dr. Rademacher reports honoraria for talks and educational support from Desitin, EISAI, UCB, and honoraria for advisory boards by UCB and EISAI; Dr. von Wrede reports personal fees from Apocare, personal fees from Eisai, other from GW pharma, personal fees from UCB, personal fees from Desitin, outside the submitted work; Prof. Dr. Surges reports personal fees from Bial, personal fees from Eisai, personal fees from LivaNova, personal fees from Novartis, personal fees from Desitin, personal fees from UCB Pharma, outside the submitted work; Prof. Dr. Helmstaedter reports personal fees from Precisis, Eisai, UCB, and GW, outside the submitted work.

Data availability statement

Due to the nature of this research, the patient of this study did not agree for her data to be shared publicly, so supporting data is not available.

Additional information

Funding

Funding was not available.