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Topiramate attenuates self-injurious behaviour in Prader-Willi Syndrome
Nathan A Shapira1, Mary C Lessig, Tanya K Murphy
1Department of Psychiatry, Evelyn F and William L McKnight Brain Institute of the University of Florida, Gainsville 32610-0256, USA. shapira@psych.med.ufl.edu
Insights
Topiramate may reduce self-injurious behavior (SIB) in Prader-Willi Syndrome (PWS) patients. An 8-week trial showed decreased SIB and improved skin lesions in PWS adults treated with topiramate.
Area of Science:
- Neurogenetics
- Psychiatry
- Pharmacology
Background:
- Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder.
- PWS is associated with psychiatric issues, including self-injurious behavior (SIB) like skin picking.
- Topiramate is an anti-epileptic drug with no significant weight gain liability.
Observation:
- This study explored the use of topiramate for SIB in PWS.
- Three adult PWS patients with SIB participated in an 8-week open-label trial.
- Topiramate treatment was associated with reduced SIB and healing of skin lesions.
Findings:
- Topiramate demonstrated an attenuation of self-injurious behavior in PWS adults.
- Resultant lesion healing was observed in patients treated with topiramate.
- The study suggests a potential role for topiramate in managing SIB.
Implications:
- These preliminary findings suggest topiramate may be a viable treatment for SIB in PWS.
- Further rigorous studies, including double-blind and cross-over trials, are warranted.
- Topiramate could potentially benefit individuals with SIB in other conditions as well.
Abstract:
Self-injurious behaviour (SIB), most notably skin picking, has been described by various terms in the literature ranging from neurotic/psychogenic excoriations to compulsive/pathological skin picking. Prader-Willi Syndrome (PWS) is a neurogenetic multisystem disorder characterized by infantile hypotonia, mental retardation, short stature, hypogonadism, dysmorphic features, and hyperphagia with a high risk of obesity. Psychiatric manifestations include SIBs in the form of skin picking, nail biting and rectal gouging. Topiramate is a novel anti-epileptic medication without significant liability of weight gain. There are no published reports of topiramate being utilized in PWS or SIB. We report attenuation of SIB with resultant lesion healing in three PWS adults treated with topiramate in an 8-wk open-label trial. Although our findings should be treated with caution, they suggest that double-blind or cross-over studies with topiramate are warranted to establish the possible role of topiramate in attenuating SIB in PWS and other disorders that involve SIB.