Magazine article Clinical Psychiatry News

Off-Label Uses of Topiramate Gather Supporting Evidence. (Tourette's Syndrome, Binge-Eating Disorder)

Magazine article Clinical Psychiatry News

Off-Label Uses of Topiramate Gather Supporting Evidence. (Tourette's Syndrome, Binge-Eating Disorder)

Article excerpt

SAN FRANCISCO -- Topiramate shows encouraging evidence of efficacy as off-label therapy for an eclectic array of disorders, according to studies presented at the annual meeting of the American Psychiatric Association.

Among the novel but nonapproved applications for which supporting data were presented at the meeting were Tourette's syndrome, binge-eating disorder, weight management in obese psychiatric patients whose psychotropic medications may be contributing to their weight problem, and as adjunctive mood-stabilizing therapy in bipolar patients.

Here are the highlights:

* Tourette's syndrome. The therapeutic challenge in this disorder has always been to reduce tics without aggravating neurobehavioral problems, or vice versa. There is a pressing need for alternatives to the standard therapies--alpha-adrenergic agents and antipsychotics--which are often ineffective or have intolerable side effects.

Dr. Teresita Y Nelson reported on 39 children and adolescents with Tourette's syndrome placed on topiramate. The antiepileptic agent was employed as add-on therapy in 32 patients with refractory tics and as monotherapy in 7. All 39 patients had both motor and phonic tics, 26 had comorbid attention deficit disorder, and 19 had obsessive-compulsive disorder.

Tic Severity Scale scores were reduced by 50% or more in 59% of patients during a mean 7.8 months of topiramate therapy, and by 75% or more in 36% of patients. More than three-quarters of treated patients displayed some clinical improvement, defined as at least a 25% decrease in Severity Scale score, said Dr. Nelson of the Carolina Neurological Institute, Charlotte, N.C.

The mean topiramate dose was 93 mg/day Eleven patients discontinued the drug because of side effects and/or lack of efficacy. Fatigue was the most commonly reported side effect, resulting in discontinuation of therapy in five patients. Tics worsened in two patients on the antiepileptic agent. Treatment-associated weight loss was not significant even in the 13 patients on concomitant stimulant therapy.

* Binge-eating disorder. Patients showed a marked and sustained reduction in binge frequency in a 1year clinical trial involving a median final topiramate dose of 200 mg/day according to Dr. Susan L. McElroy professor of psychiatry at the University of Cincinnati. …

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