Role of topiramate for the treatment of painful diabetic peripheral neuropathy

Objective. To review the possible role of topiramate for the treatment of neuropathic pain and, specifically, the pain of diabetic peripheral neuropathy. Data Sources. Clinical studies and abstracts were identified by using PubMed (January 1966-October 2003), Ovid (January 1966-December 2003), and International Pharmaceutical Abstracts (January 1970-December 2003) and by reviewing bibliographies of published studies. Key search terms included pain, peripheral neuropathy, diabetes, and topiramate. English-language studies were identified, as were pertinent references from these articles. Data Synthesis. Published data are limited on the successful use of topiramate in the treatment of neuropathic pain syndromes, and only three prospective studies evaluated the effectiveness of topiramate in diabetic peripheral neuropathy. In addition, the use of topiramate to treat diabetic neuropathic pain syndromes successfully may be limited by patients' inability to tolerate the adverse effects associated with the agent. Conclusions. Topiramate has been used successfully in relieving the pain of various neuropathies, including painful diabetic peripheral neuropathy. Randomized controlled trials that specifically focus on the use of topiramate in patients with painful diabetic peripheral neuropathy are needed to confirm the initial findings in case reports, abstracts, and small clinical trials that have focused on treating numerous neuropathic pain syndromes, including diabetic peripheral neuropathy.