[Psychosis following treatment with topiramate]

In three patients, two men aged 33 and 43 years receiving treatment for epilepsy, and one woman aged 31 years with mild mental retardation and psychotic episodes, psychotic symptoms emerged soon after the introduction of topiramate. These symptoms were associated with agitation/aggressive behaviour and significant weight loss. Psychotic symptomatology gradually disappeared after discontinuation of topiramate without the administration of an antipsychotic. Over the past years several novel anticonvulsants, including topiramate, have become available for the treatment of refractory partial seizures, with or without secondary generalisation. Some of them have been demonstrated to be effective in bipolar affective disorders as well. Treatment with topiramate can be associated with neuropsychiatric side-effects such as cognitive impairments, deficits in word finding, and incidental psychotic decompensation. Significant weight loss is often noted as well. Since psychiatric and cognitive side-effects may occur during treatment with topiramate, careful evaluation is mandatory especially in patients with a psychiatric history.