Topiramate의 인지기능에 대한 효과

Abstract

Cognitive impairments are important to take into account in the management of patients with epilepsy. The importance of these effects varies between epilepsy syndromes and according to seizure type and frequency. Treatment with certain antiepileptic drugs can also lead to deterioration in cognitive functions. Topiramate (Topamax®) is a structurally novel broad-spectrum antiepileptic drug (AED) with established efficacy as monotherapy or adjunctive therapy in the treatment of adult and pediatric patients. Cognitive adverse events have been reported in from 10% to 15% of patients treated with topiramate. Cognitive dysfunction associated with topiramate is generally mild to moderate in severity and primarily affects cognitive language and working memory. But it may improve with slower titration and dosage adjustments. Difficulties in verbal fluency (i.e. word-finding ability) appear to be rather specific for topiramate and are rarely seen with other AEDs. Cognitive side effects of topiramate may be related to changes in GABAergic activity in the cerebral cortex, notably in the frontal lobes. GABAergic dysfunction in the prefrontal cortex could lead to mental slowing and subsequent spread of this dysfunction to the dorsolateral areas, including Broca’s area, could underlie impairments of language production.