Effect of topiramate on cognition in obese children.

摘要

Topiramate (TPM) is effective as mono- and adjunctive treatment for epilepsy and migraine in adults and children. Side effects may include headache, dizziness, drowsiness, gastrointestinal, and cognitive problems. Weight loss occur in 6 to 15% of the patients depending on dose in a dose-comparison trial of TPM as monotherapy in recently diagnosed partial epilepsy.2 With use of this side effect, TPM was found to be effective as treatment for adults with binge-eating disorder and for obesity in children with Prader-Willi syndrome. We systematically assessed the effect of TPM on cognition in obese children, who were included in an open label study on the effect of TPM on body mass index.Methods. We prospectively recruited 14 Dutch children from the outpatient clinics of pediatrics and pediatric neurology of our university hospital. Inclusion criteria were body mass index exceeding +2.3 SD corrected for gender and age, age 4 to IS years, informed consent of parents and children older than 12 years, and failure of dietary measures or controlled exercises to reduce weight. Exclusion criteria were liver or kidney failure, untreated hypopituitary dysfunction or insufficient fluid intake, and treatment with antiepileptic or sedative medication. Six obese children had been treated for a brain tumor (five craniopharyngioma, one primitive neuroectodermal tumor) and eight had an alimentary obesity. They all had been in a stable medical condition for at least 1 year. Children were examined before and 3, 6, and 12 months after start of TPM. Dose was increased in 25-mg weekly increments until the maximum target dose of 7.0 mg/kg/day was achieved. In case of cognitive dysfunction, TPM dose was diminished to the dose at which no such complaints occurred. Neuropsychological assessment included nonverbal intelligence, memory, attention, language, and visual-spatial skills. Tests were controlled for test-retest effects (table). Test scores were converted into Z scores and were analyzed with the x2 test, the Kolmogorov-Smirnov test, and Wilcoxon ranks test by means of SPSS 12.0.