The Role of Hippocampal Sclerosis in Topiramate-related Depression and Cognitive Deficits in People with Epilepsy

Authors

  • Marco Mula,

    1. Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, England
    2. Department of Neurology, Amedeo Avogadro University, Novara, Italy
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  • Michael R. Trimble,

    1. Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, England
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  • Josemir W. A. S. Sander

    1. Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, England
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Address corresponding and reprint requests to Dr. M. Mula at Department of Neurology, Amedeo Avogadro University, C.so Mazzini, 18, 28100 Novara, Italy. E-mail: marcomula@yahoo.it

Abstract

Summary: Purpose: To clarify the role of hippocampal sclerosis (HS) in developing psychiatric and cognitive adverse events during therapy with topiramate (TPM) in patients with temporal lobe epilepsy (TLE).

Methods: We analyzed the data of 70 patients with TLE and HS and 128 patients with cryptogenic TLE matched for age, sex, starting dose, and titration schedule of TPM. They were selected from the first consecutive 431 patients started on TPM between 1995 and 1999.

Results: Patients with HS were more likely to develop cognitive adverse events (CAEs; p = 0.002) and depression (p = 0.018) and to be receiving a polytherapy regimen (p = 0.007). However, regression analysis demonstrated that only HS was a predictive factor for the occurrence of CAEs (OR = 2.4; p < 0.001) and depression (OR = 2.3; p = 0.02).

Conclusions: Patients with TLE and HS were more prone to develop CAEs and depression than were patients with cryptogenic TLE, during TPM therapy, despite the same titration schedule. The presence of HS and not duration of epilepsy or polytherapy regimen represented the main risk factor.

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