During a task measuring verbal fluency, topiramate disrupts relevant areas for brain activation and deactivation.
Verbal fluency is associated with activation in areas of the frontal lobe, whereas demanding cognitive (or motor) tasks are linked to deactivation of the default mode network. Of the newer antiepileptic drugs, topiramate and zonisamide produce significant adverse cognitive effects. This retrospective analysis of cross-sectional data on 145 patients with refractory focal epilepsy reveals the physiologic basis of these complaints.
Patients were treated with levetiracetam (median dose, 2000 mg), zonisamide (median dose, 224 mg), or topiramate (median dose, 312.5 mg). In a presurgical evaluation, patients had functional magnetic resonance imaging while performing a verbal-fluency task. Other cognitive domains were tested separately.
Topiramate wa…
Reviewing Author
DisclosuresRoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions
Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience
Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)
DisclosuresRoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions
Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience
Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)