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Zonisamide for Migraine Prophylaxis in Topiramate-Intolerant Patients: An Observational Study

Authors

  • Veronica Villani MD,

    1. From the Neurology Headache Centre, S. Andrea Hospital, Sapienza University, Rome, Italy (V. Villani, A. Ciuffoli, and G. Sette); Department of Neurology and Psichiatry, Sapienza University, Department of Neurology and Psichiatry Rome, Italy (L. Prosperini).
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  • Alessandro Ciuffoli MD,

    1. From the Neurology Headache Centre, S. Andrea Hospital, Sapienza University, Rome, Italy (V. Villani, A. Ciuffoli, and G. Sette); Department of Neurology and Psichiatry, Sapienza University, Department of Neurology and Psichiatry Rome, Italy (L. Prosperini).
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  • Luca Prosperini MD,

    1. From the Neurology Headache Centre, S. Andrea Hospital, Sapienza University, Rome, Italy (V. Villani, A. Ciuffoli, and G. Sette); Department of Neurology and Psichiatry, Sapienza University, Department of Neurology and Psichiatry Rome, Italy (L. Prosperini).
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  • Giuliano Sette MD, PhD

    1. From the Neurology Headache Centre, S. Andrea Hospital, Sapienza University, Rome, Italy (V. Villani, A. Ciuffoli, and G. Sette); Department of Neurology and Psichiatry, Sapienza University, Department of Neurology and Psichiatry Rome, Italy (L. Prosperini).
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  • Funding: This research was carried out using information collected during normal patient care, and extra time spent in data analysis and interpretation was part of educational programs within the University; no external source of funding was required.

  • Conflict of Interest: All the authors have no conflict of interest to declare.

V. Villani, Neurology Unit, S. Andrea Hospital, Sapienza University, Via di Grottarossa, 1035-00189 Rome, Italy.

Abstract

(Headache 2011;51:287-291)

Background.— Zonisamide, a sulfonamide analog, is an antiepileptic drug with mechanisms of action similar to topiramate. Because of its pharmacodynamic and pharmacokinetics profiles, zonisamide is also potentially suitable for migraine prevention.

Methods.— Tolerability and effectiveness of zonisamide for migraine prophylaxis in patients with a good response to topiramate, but interrupting it for intolerable side effects, were evaluated in 34 patients. After a 1-month period of wash-out, patients were treated with zonisamide (up to a 100 mg/day dosage) for 6 consecutive months.

Results.— Zonisamide was well tolerated, only 4 (12%) patients reported transient and tolerable side effects. Mean number of days with headache per month was reduced from 14.9 ± 5.3 during the wash-out period to 2.5 ± 0.6 after 6 months of zonisamide (P < .001). We observed a significant reduction in headache severity and disability, as assessed by visual analog scale and migraine disability assessment scale. Finally, when compared with the 1-month period prior to starting zonisamide, a reduced use of analgesics was recorded at the end of the follow-up.

Conclusion.— Our findings support the use of zonisamide as an alternative therapy for migraine prevention in patients with good response, but poor tolerance to topiramate.

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