Reversible Dementia Secondary to

We report on an elderly patientwho developed dementia with topiramatethat resolved on withdrawal of treatment. Asearch through PubMed found no publishedreport of dementia secondary to this drug.A 77-year-old woman was prescribedtopiramate by a psychiatrist because of a de-pressive disorder up to a dose of 200 mg/d.The dose was titrated for 6 weeks. Thepatient was also taking sertraline 50 mg/d.Although depressive symptoms were im-proved after 1 month with topiramate, shegradually developed a dementing disordercharacterized by forgetfulness, languageproblems, and difficulty in performing dailyactivities like shopping.When the patient was evaluated in theneurology clinic, she was taking topiramate200 mg/d for 3 months. Her relatives had notnoticed hallucinations, drowsiness, or sleepdisturbances. On examination, she was alertand cooperative. She was disoriented in timeand recalled only 1 of 3 items at 5 minutes.She had difficulty in naming objects, and herperformance in the Semantic Verbal FluencyTest (animals in 1 minute) was significantlylow. The score on the Mini-Mental StateExamination was 18. A diagnosis of dementiawas made according to the Diagnostic andStatistical Manual of Mental Disorders,Revised Third Edition criteria. A magneticresonance imaging study of the brain wasnormal. The levels of serum electrolytes,calcium, phosphorus, protein, glucose,creatinine, liver enzymes, thyroid hormones,vitaminB-12andfolate,andacompletebloodcount were normal. A serological test forsyphilis was negative.Topiramate was withdrawn, and 1week later, improvement was noted. Herfamily mentioned that the patient’s languagewas improved, and she was able to goshopping again. When she was evaluated inthe neurology clinic 1 month later, her scoreon the Mini-Mental State Examination was 29.Topiramate causes clinically significantdeclines in word fluency and poorer psycho-motor speed and attentional performance inhealthy young adults.