Regular Article| Volume 8, ISSUE 4, P235-237, June 1999

Download started.


Acute psychotic symptoms induced by topiramate

      This paper is only available as a PDF. To read, Please Download here.


      The incidence of psychosis during clinical trials of topiramate was 0.8%, not significantly different from the rate for placebo or reported rates of psychosis in patients with refractory epilepsy. We observed psychotic symptoms in five patients soon after initiation of topiramate therapy. We performed a retrospective chart review of the first 80 patients who began on topiramate after approval for clinical use, between January and April 1997. Symptoms suggestive of psychosis, including hallucinations and delusions, were sought for analysis. Cognitive effects such as psychomotor slowing, confusion, and somnolence were not included. Five patients developed definite psychotic symptoms 2 to 46 days after beginning topiramate. Dosages at symptom onset were 50–400 mg/day. Symptoms included paranoid delusions in four patients and auditory hallucinations in three. Symptoms of psychosis and other psychiatric symptoms resolved quickly with discontinuation of topiramate in three patients, dose reduction from 300 to 200 mg/day in one and with inpatient treatment and neuroleptics in another. One patient had a history of auditory hallucinations, one of aggressive and suicidal thoughts, but three had no significant psychiatric history. Physicians should be aware of the possibility of psychotic symptoms, even in patients without a previous psychiatric history, when prescribing topiramate. Symptoms resolve quickly with discontinuation.




        • Wilder B.J.
        Antiepileptic drugs—current use.
        Canadian Journal of Neurological Science. 1996; 23 (Suppl. 2): S18-S23
        • Pakalnis A.
        • Drake M.E.
        • Kuruvilla J.
        • Kellum J.B.
        Forced normalization.
        Archives of Neurology. 1987; 44: 289-292
      1. M. W. Tyler, E. Q. King, 147, 17, 21

        • Lee D.O.
        • Steingard R.J.
        • Cesena M.
        • Helmers S.L.
        • Riviello J.J.
        • Mikati M.A.
        Behavioral side-effects of gabapentin in children.
        Epilepsia. 1996; 37: 87-90
        • Trimble M.R.
        The psychosis of epilepsy and their treatment.
        Clinical Neuropharmacology. 1985; 8: 211-220
        • Landolt H.
        Some clinical electroencephalographical correlations in epileptic psychosis (twilight studies).
        Electroencephalography and Clinical Neurophysiology. 1953; 5: 121
        • Wolf P.
        Acute behavioral symptomatology at disappearance of epileptiform EEG abnormality: paradoxical or forced normalization.
        Advances in Neurology. Raven Press, New York1991 (p. 127–142)
        • Dohmeier C.
        • Kay A.
        • Greathouse N.
        Neuropsychiatric complications of topiramate therapy.
        Epilepsia. 1998; 39 (Suppl. 6)