| Background Topiramate is a novel broad-spectrum antiepileptic drug with established efficacy as monotherapy or adjunctive therapy in the treatment of adult and paediatric patients with generalised tonic-clonic seizures, partial seizures with or without generalised seizures, and seizures associated with Lennox-Gastaut syndrome. The domestic and foreign studies have found neuropsychological impairments in patients with epilepsy receiving TPM therapy.Objective This study gathered the related literatures about the effect of topiramate on cognitive function in patients with epilepsy at home and abroad in recent years. A Meta analysis was conducted to illuminate the effect of topiramate on cognitive function in adult patients with epilepsy through observing the Minimum Mental State Examinationthe(MMSE) or event related potential P300. Quantitative analysis of cognitive-related adverse drug events(ADEs) was perfonned using meta-analysis with non-comparative binary data.Methods According to the Cochrane reviews, the pertinent literatures about the effect of topiramate on cognitive function in patients with epilepsy were collected by retrieving the electronic databases, including MEDLINE, EMBASE, Cochrane Library, Pub Med, CNKI, Wanfang, Weipu and also by searching at www.baidu.com and www.google.cn. The literatures that met the inclusion criteria were meta-analyzed by Review Manager 5.3 from the Cochrane Collaboration.Results A total of five literatures were included(topiramate treatment 0.5mg/kg daily as an initial dose and ≤400mg daily as a maintenance dose). Meta analysis revealed significantly reduced scores of MMSE in patients with 2-3 months of treatment compared to that before treatment(Z =5.73, WMD =-2.80, 95% CI was between-3.75 and-1.84, P < 0.01), but the differences in scores of MMSE with 6-8 months of treatment were not significant(P> 0. 05). The latency of P300 in patients with 2-3 months of topiramete treatment shortened significantly than that before treatment(Z =19.82, WMD = 36.60, 95% CI was between 32.98 and 40.22, P < 0.01), but the change in the latency of P300 in patients with 6-8 months treatment and amplitude of P300 were not significantly different(P> 0. 05). Eleven studies were finally included in this Meta analysis. The incidence and 95% confidence interval of cognitive-related ADEs: psychomotor slowing 0.08(0.03-0.12), concentration/attention difficulty 0.08(0.04-0.15), paresthesia 0.07(0.05-0.11), fatigue 0.19(0.09-0.33), somnolence 0.15(0.12-0.18), memory difficulty 0.07(0.03-0.12), speech and language disturbance 0.07(0.02-0.21). All of the incidences above had statistical significance(P < 0.01).Conclusion The present limited evidence indicates that topiramate treatment with low dose, slow titration and low target dose may lead to cognitive function impairments, which often occurred in the slow titration. When reaching the maintenance dose, there were no apparent differences in cognitive effects of topiramate instead. The incidence of cognitive-related ADEs was low in children received topimmate treatment. In future, it is necessary to carry out more prospective, large sample, multicenter, randomized double-blind controlled monotherapy trials to improve the strength of the evidences. Meanwhile, the combination of P300 and MMSE should be adopted in the evaluation of cognitive function in patients with epilepsy, which can make the result more objective and comprehensive. |
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