Topiramate
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Topiramate Hypohidrosis in children: 2 case reports Two children developed hypohidrosis during treatment with topiramate for epilepsy. Patient 1, a 6-year-old boy, had cryptogenic partial seizures and started receiving topiramate after his second seizure; the dose was titrated to 75 mg/day. After 4 months’ treatment, he began experiencing sweat reduction, dry skin, fatigue, irritability and a red face, associated with hot temperatures or physical exercise. A pilocarpine iontophoresis sweat test showed he had a reduced sweat response. Electrophysiological studies revealed normal sensory and motor nerve conduction, normal laser-evoked potentials, but absent sympathetic skin responses. Topiramate was gradually withdrawn and replaced with valproic acid, and after 1 month his symptoms resolved. Patient 2 was also a 6-year-old boy with cryptogenic complex partial seizures, who started receiving topiramate at the age of 5 years. The dose was gradually titrated to 100 mg/day. After 6 months of treatment, he started to develop sweat reduction, neck and face redness and hyperthermia, associated with physical stress or hot temperatures. Results of a sweat test and electrophysiological studies were identical to those of patient 1. Following gradual withdrawal of topiramate, his symptoms resolved. Author comment: "These findings [electrophysiological studies] might suggest a transitory autonomic dysfunction related to a specific carbonic anhydrase block at the level of sweat glands, although the exact role of isoenzymes II and IV in reducing sweating capacity is still not clearly elucidated." Margari L, et al. Electrophysiological study in 2 children with transient hypohidrosis induced by topiramate. Clinical Neuropharmacology 31: 339-346, No. 801124962 6, Nov-Dec 2008 - Italy
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Reactions 13 Dec 2008 No. 1232
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