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Topiramate and word-finding difficulties in patients with epilepsy

From the Department of Clinical & Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, UK.

Address correspondence and reprint requests to Prof. Michael R. Trimble, Professor of Behavioral Neurology, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; e-mail: mtrimble{at}ion.ucl.ac.uk

Objective: To evaluate the prevalence of word-finding difficulties as a treatment-emergent adverse event in patients with epilepsy taking topiramate and to identify a clinical phenotype at risk.

Methods: The authors investigated the relationship of word-finding difficulties to topiramate titration schedule, seizure frequency and pattern, and EEG and neuroradiologic findings in 431 consecutively and prospectively collected patients taking topiramate.

Results: Thirty-one patients (7.2%) developed word-finding difficulties. Presence of simple partial seizures (OR = 6.7 p = 0.007) and a left temporal EEG epileptic focus (OR = 5.2 p = 0.021) were significantly associated with word-finding difficulties.

Conclusions: The presence of word-finding difficulties seems to be a titration schedule independent phenomenon that occurs in a subgroup of patients with a specific biologic vulnerability.

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