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Topiramate Overdose: Clinical and Laboratory Features
Toufic Fakhoury1, Lindsay Murray, Donna Seger
1Department of Emergency Medicine, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia
Epilepsy & Behavior : E&B
|March 1, 2003
Summary
Topiramate overdose can lead to coma and status epilepticus. Patients may develop persistent non-anion-gap metabolic acidosis, potentially due to carbonic anhydrase inhibition.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Limited data exist on overdose cases involving newer antiepileptic drugs.
- Topiramate is a widely used antiepileptic drug with a known side effect profile, but overdose data is scarce.
Purpose of the Study:
- To describe the clinical presentation and outcomes of topiramate overdose.
- To investigate potential mechanisms for observed metabolic abnormalities in topiramate overdose.
Main Methods:
- Retrospective review of medical records for two patients with topiramate overdose.
- Detailed recording of patient histories, neurological examinations, laboratory findings, and clinical progress.
Main Results:
- Both patients experienced coma and generalized convulsive status epilepticus, necessitating intubation and benzodiazepine treatment.
- A persistent non-anion-gap metabolic acidosis was observed in both patients for 5-6 days post-overdose.
- Recovery occurred within 2 days, but metabolic acidosis was a notable sequela.
Conclusions:
- Topiramate overdose can cause severe neurological events, including status epilepticus.
- Non-anion-gap metabolic acidosis is a potential complication of topiramate overdose, possibly linked to carbonic anhydrase inhibition.
- Clinicians should monitor patients on topiramate for depression and be vigilant for overdose complications.