Evaluation of a Rapid Topiramate Titration Scheme for the Early Detection of Cognitive Side Effects

Background Topiramate (TPM) is effective for treating epilepsy, but executive dysfunction is a common side effect that could significantly affect everyday life. Additionally, previous studies have suggested that patients might be unaware of these changes. Objective To evaluate a rapid TPM titration scheme for the early detection of adverse cognitive side effects. Methods In this retrospective study, we assessed changes in objective cognitive performance (EpiTrack (R)) after rapidly titrating TPM (50 mg per day during an inpatient stay) in 49 epilepsy patients and compared those results with an outpatient control group that underwent the recommended standard titration (n = 23 with 25-50 mg per week). Results Using Bayesian statistics, analyses revealed decisive evidence of a negative effect on cognitive performance when TPM was introduced (BF 31480000000) independent of the titration speed (BF 0.739). When using a fast titration rate, deficits in executive function increased from a baseline of 53.1 to 73.5% at follow-up, and 55.1% experienced a statistically significant intraindividual decline. When using the standard titration scheme, impairments increased from 52.2 to 65.2%, with an intraindividual deterioration found in 52.2% of the patients. Conclusion Physicians might be able to detect adverse cognitive side effects sooner in epilepsy patients if TPM is administered using a faster titration rate while applying repeated cognitive assessments within days. This approach might help prevent any unnoticed intolerance and eventual negative consequences for the patient. Therefore, we recommend monitoring early on for adverse changes instead of withholding a potentially effective treatment option because of anticipated side effects.

Automated summary

This retrospective study found that rapid titration of topiramate significantly impairs executive function, while the traditional titration scheme also leads to cognitive impairments. Therefore, it is recommended to use a faster titration rate and perform repeated cognitive assessments when administering topiramate to epilepsy patients.