Topiramate
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Topiramate Facial myoclonus: 2 case reports A 28-year-old man and a 49-year-old woman developed facial myoclonus during treatment with topiramate. The man, who had post-traumatic frontal lobe epilepsy, started receiving topiramate 25 mg/day with weekly dosage increases of 25mg; his previous therapy with phenytoin was simultaneously tapered off. Four days after he started receiving topiramate 75mg twice daily, symmetrical and synchronous twitching of his facial muscles developed, mainly of those muscles involving his forehead. Clusters of up to 10 seconds’ duration and with a frequency of 6–8Hz were noted on electromyography; every jerk lasted for 50–100ms. His topiramate dosage was decreased. Facial myoclonus gradually improved and resolved at a dosage of 100 mg/day. Over the following few weeks, topiramate was stopped. He started oxcarbazepine monotherapy and myoclonus did not recur during 10 months of follow-up. The woman experienced new-onset complex partial seizures and started receiving topiramate 25mg twice daily; the dosage was increased by 25 mg/week. She developed clusters of synchronous, symmetrical facial twitches 3 days after reaching a topiramate dosage of 150 mg/day. The twitches involved her periorbital muscles and forehead, were very frequent and distressing. Her topiramate dosage was decreased. Facial myoclonus resolved at a daily dosage of 100mg and did not recur during 7 months of follow-up. Author comment: "The emergence of facial myoclonus after the exposure to [topiramate] and its disappearance subsequent to dose reduction suggest a possible causal relationship between the facial myoclonus and [topiramate]." Kutluay E, et al. Reversible facial myoclonus with topiramate therapy for epilepsy. 801091182 Epilepsia 48: 2001-2002, No. 10, Oct 2007 - Turkey
0114-9954/10/1164-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 11 Aug 2007 No. 1164
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