topiramate / Generic mfg. - LARVOL DELTA

Drugs for Migraine Prophylaxis. (PubMed, Dtsch Arztebl Int) - "The new prophylactic drugs against migraine are effective, well-tolerated, and especially useful for patients for whom traditional oral migraine prophylactic drugs and onabotulinum toxin A are ineffective, not tolerated, or contraindicated."

Journal • CNS Disorders • Migraine • Pain

Botulinum Toxin Type A for the Prevention of Migraines: An Umbrella Review of Systematic Reviews. (PubMed, Toxins (Basel)) - "Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments."

Journal • Review • CNS Disorders • Migraine • Pain

Pharmacologic treatment of tics and Gilles de la Tourette syndrome. (PubMed, Handb Clin Neurol) - "The strongest evidence supports the use of dopamine receptor antagonists, particularly atypical antipsychotics such as aripiprazole and risperidone. However, other agents - including α-2 adrenergic agonists, vesicular monoamine transporter 2 inhibitors, and topiramate - also play an important role in treatment strategies. Pharmacologic management of GTS should be individualized, taking into account symptom severity, functional impact, and the risk-benefit profile of each therapeutic option."

Journal • Review • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • CNS Disorders • Mood Disorders • Movement Disorders • Obsessive-Compulsive Disorder • Psychiatry • Tourette Syndrome

PLUTO: Combining Latency Reversing Agents to Address the HIV Reservoir (clinicaltrials.gov) - P1/2 | N=30 | Not yet recruiting | Sponsor: Erasmus Medical Center

New P1/2 trial • Human Immunodeficiency Virus • Infectious Disease • CD4

Severe Refractory NORSE with Bilateral Thalamostriatal Involvement: Anakinra Rescue After Multidrug Failure (ACTRIMS Forum 2026) - "Extensive infectious, autoimmune, and paraneoplastic evaluation was only positive for norovirus on stool PCR.Despite multiple antiseizure medications (levetiracetam, lacosamide, valproate, phenobarbital, clobazam, rufinamide, perampanel, topiramate, ketamine) plus IVIG, high-dose corticosteroids, and tocilizumab, GPDs persisted and the patient remained critically ill. Cytokine-directed therapy, particularly anakinra, may be effective in cryptogenic NORSE unresponsive to conventional antiseizure and first-line immunotherapies. Early recognition and targeted immunomodulation can improve outcomes in severe, refractory cases."

CNS Disorders • Epilepsy • Immunology • Musculoskeletal Pain

Evaluation of clinically approved neuroprotective drugs as adjunct therapies in experimental cerebral malaria. (PubMed, Arch Microbiol) - "topiramate, rasagiline, vinpocetine, cilostazol, piracetam, and rivastigmine were tested for both antimalarial and anti-cerebral malaria activity. Overall, these results suggest that combining rivastigmine with α/β-arteether may represent a practical and low-cost adjunct therapy for CM. Further mechanistic and clinical studies will be essential to confirm these findings and assess long-term outcomes."

Journal • Infectious Disease • Malaria

Do Cenobamate Pharmacokinetics Change with Co-Administered Antiseizure Medications? An Exploratory Analysis of Responder Patients with Focal Drug-Resistant Epilepsy. (PubMed, Pharmaceutics) - "Higher CNB concentrations were observed in patients co-treated with lacosamide, while concomitant topiramate was associated with lower exposure. Carbamazepine and valproate showed non-significant trends consistent with their known enzyme-inducing and inhibiting properties...These findings highlight the importance of therapeutic drug monitoring and individualized titration strategies to optimize efficacy and safety in clinical practice. These results should be regarded as exploratory and hypothesis-generating due to the small and monocentric sample size and need to be confirmed in larger, multicenter cohorts."

Journal • PK/PD data • CNS Disorders • Epilepsy

Analysing ocular structural morbidities in younger adults using anti-seizure drugs: a cross-sectional study. (PubMed, Int Ophthalmol) - "Prolonged ASD treatment is linked to observable changes in ocular structure, including dry eye disease, myopia, macular edema, and RNFL thinning. These outcomes highlight the necessity for routine ophthalmic evaluation and collaborative care to prevent irreversible visual impairment in individuals with epilepsy."

Journal • Observational data • CNS Disorders • Dry Eye Disease • Epilepsy • Macular Edema • Ophthalmology

Challenges in the management of idiopathic intracranial hypertension. (PubMed, J Neurointerv Surg) - "Pharmacologic therapies such as acetazolamide, topiramate, and glucagon-like peptide-1 (GLP-1) receptor agonists offer benefits but are limited by the side effect profile and poor efficacy. Surgical approaches often address only a portion of IIH's multifactorial pathophysiology, and recurrent symptoms may arise from persistent venous hypertension or new venous stenoses. This review evaluates the current evidence on medical and surgical treatment failures in IIH, emphasizing unresolved questions in disease pathogenesis and the need for personalized therapeutic approaches that advance the development of more durable treatment options."

Journal • Review • Cardiovascular • CNS Disorders • Hypertension • Obesity

Treating the Pain After the Cure: Therapeutic Approaches for Post-ECT Headache-A Systematic Review. (PubMed, J ECT) - "Treatments evaluated included sumatriptan, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, propranolol, topiramate, valproic acid, mirtazapine, dihydroergotamine, topical salicylates, cryotherapy, and percutaneous electrical nerve stimulation. However, clinical phenotyping and a stepwise therapeutic approach may improve symptom control. This review provides a comprehensive summary of current options and offers guidance for individualized management of post-ECT headache."

Journal • CNS Disorders • Migraine • Musculoskeletal Pain • Pain

Update on Medical Treatments for Essential Tremor: An International Parkinson and Movement Disorder Society Evidence-Based Medicine Review. (PubMed, Mov Disord) - "Current evidence from RCTs with at least 1 month of follow-up is insufficient to confidently support the efficacy of available medical treatments for ET. There is a need for longer, higher-quality clinical trials to improve treatment recommendations and guide decision-making for clinicians and patients with ET."

Journal • Review • CNS Disorders • Essential Tremor • Movement Disorders • Parkinson's Disease

Sex-specific elevated incidence of glaucoma associated with topiramate versus valproate or lamotrigine in epilepsy, not migraine: A population-based cohort study. (PubMed, Epilepsia) - "Topiramate use substantially increases glaucoma risk compared with valproate and lamotrigine, particularly among female or epilepsy patients. No significant association in male or migraine patients was observed. These findings may inform targeted ophthalmologic monitoring in high-risk groups and use of alternative ASMs."

Journal • CNS Disorders • Epilepsy • Glaucoma • Migraine • Ophthalmology • Pain

Diagnosis and management of migraine in adults: a population-based study in England. (PubMed, BJGP Open) - "The majority of headache presenting to primary care remains undifferentiated/unclassified. Only one-third of patients diagnosed with migraine receive triptans or preventive medication. Acute medication overprescription is common and preventive medicines are poorly optimised."

Journal • CNS Disorders • Migraine • Pain • Preventive care

Atogepant in episodic cluster headache: A case report on efficacy and tolerability (EHF-EHC 2025) - "Previous preventive therapies with high-dose verapamil (240 mg twice daily) and topiramate (50 mg/day) offered limited benefit, with 1-2 bouts of the disease each year. This case suggests that atogepant may represent a promising preventive approach for selected patients with episodic cluster headache, particularly when conventional treatments fail. Although adverse effects limited its use in this case, the rapid and complete response warrant further investigation. Controlled studies are warranted to assess its efficacy, safety and potential role in the management of cluster headache."

Case report • Clinical • Anorexia • Pain

Migraine worsening after excellent initial response to galcanezumab (EHF-EHC 2025) - "Several prophylactics were tried (topiramate, amitriptyline, and atogepant) with no improvement...However, in the last few months of treatment, she experienced recrudescence of symptoms – she's now awaiting treatment with eptinezumab...While he tried several preventive medications (topiramate, amitriptyline, venlafaxine and valproic acid), he was also medicated with corticosteroids... Recent literature and medical experience refer to Galcanezumab as a good sustained treatment to refractory migraine. However, these cases highlight the situations in which, despite the initial response being great, there's no prolonged effect on pain relief."

Cardiovascular • CNS Disorders • Complement-mediated Rare Disorders • Hepatology • Hereditary Angioedema • Migraine • Pain

Patient-reported outcomes of atogepant versus topiramate in participants requiring preventive treatment for migraine: Results from the head-tohead TEMPLE trial (EHF-EHC 2025) - "Atogepant 60 mg QD demonstrated clinically meaningful and statistically superior improvements in all secondary functional outcomes compared with topiramate."

Clinical • Head-to-Head • Patient reported outcomes • CNS Disorders • Migraine • Pain • TOP1

Refractory chronic cluster headache: A new therapeutic option (EHF-EHC 2025) - "Acute therapy with oral zolmitriptan 5 mg, subcutaneous sumatriptan 6 mg, and oxygen were used, with moderate effect. Preventive treatment included prednisolone and occipital nerve block during exacerbations, and verapamil, both as monotherapy and in combination with topiramate and lithium in various regimens... Treating refractory chronic cluster headache is challenging, as it is highly disabling for the patient. Although other therapies targeting CGRP have not shown clear benefit in clinical trials, especially in chronic forms, atogepant may offer a promising alternative."

Anorexia • Cardiovascular • Chronic Cluster Headache • CNS Disorders • Constipation • Gastroenterology • Gastrointestinal Disorder • Hypertension • Migraine • Pain

Comparison of atogepant versus topiramate on cognitive function as assessed by the PROMIS cognitive function abilities subset SF 6a v2.0 for participants requiring preventive treatment for migraine: Results from the head-to-head TEMPLE trial (EHF-EHC 2025) - "Ato 60 mg QD demonstrated greater improvements in cognitive function compared with topi through Week 24. Fig. 1"

Head-to-Head • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Migraine • Pain • TOP1

Middle meningeal artery lidocaine infusion for refractory migraine: First case report in Portugal (EHF-EHC 2025) - "Various pharmacologic classes were tried without benefit: antihypertensives and calcium channel blockers (propranolol, candesartan, flunarizine), antiepileptics (valproic acid, topiramate, oxcarbazepine), antidepressants (amitriptyline, nortriptyline, venlafaxine, fluvoxamine, sertraline, clomipramine), other preventives (prednisolone, oxitriptan, melatonin), cycles of botulinum toxin (PREEMPT protocol), monoclonal antibodies (galcanezumab, fremanezumab, erenumab), and atogepant. At the time of the procedure, the patient was on eptinezumab 100 mg and botulinum toxin every three months but continued to have daily headaches, with severe intensity and reliance on eletriptan for acute relief... MMA lidocaine infusion has been described in few cases, and this is, to our knowledge, the first reported in Portugal. It constitutes an invasive therapeutic approach that should be considered only as a rescue option for carefully selected patients with severely refractory migraine...."

Case report • Clinical • Anorexia • CNS Disorders • Migraine • Pain

Tolerability, safety, and efficacy of atogepant versus topiramate in participants requiring preventive treatment for migraine: Results from the head-tohead TEMPLE trial (EHF-EHC 2025) - "Atogepant 60mg QD demonstrated superior tolerability and efficacy compared with topiramate. Atogepant was generally safe and well tolerated and no new safety signals were identified."

Clinical • Head-to-Head • CNS Disorders • Migraine • Pain • TOP1

Bayesian-Based Pharmacokinetic Framework Integrated with Therapeutic Drug Monitoring for Assessing Adherence to Antiseizure Medications: A Clinical Trial Simulation Study. (PubMed, J Med Internet Res) - "This study proposed an innovative Bayesian-based pharmacokinetic (PK) framework integrated with TDM data to address the above limitations, with a focus on 14 widely prescribed ASMs, including brivaracetam, carbamazepine, clobazam, eslicarbazepine acetate, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, phenobarbital, topiramate, valproic acid, vigabatrin, and zonisamide. This study establishes a Bayesian-based PK approach to enhance the assessment of ASMs adherence. This approach facilitates a paradigm shift from population-based management to patient-specific adherence profiling, offering a practical methodology for the precise evaluation of medication-taking behaviors."

Journal • PK/PD data • CNS Disorders • Epilepsy

Treatment Approaches for Obesity in Children With Heterozygous MC4R Variants. (PubMed, Clin Obes) - "We describe significant improvement in weight in three patients with pathogenic or likely pathogenic MC4R mutations; two adolescents treated with semaglutide, and a younger child treated with metformin and topiramate. These findings indicate GLP-1 receptor agonists, topiramate and metformin can be helpful in managing obesity associated with MC4R deficiency."

Journal • Genetic Disorders • Obesity • MC4R

Migraine burden in postmenopausal women and the need for prophylactic treatment (EHF-EHC 2025) - "The most prescribed agents were amitriptyline (37%), topiramate (27%), and propranolol (10%)...The most common acute medications were zolmitriptan (10%), paracetamol (8.6%), and ketorolac (8.6%)... Our findings highlight the persistent burden of migraine after menopause and support the ongoing need for prophylaxis in a majority of patients. This may challenge assumptions of reduced treatment need post-menopause and suggests a specific phenotype of late-life persistent migraine."

Clinical • Cardiovascular • CNS Disorders • Depression • Hypertension • Migraine • Pain • Vascular Neurology

The real pain of abuse: Not all bruises are visible (EHF-EHC 2025) - "The hypothesis of short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) was considered, but there was no response to either lamotrigine nor topiramate at therapeutic doses...The hypothesis of hemicrania continua was considered, but again there was no response to indomethacin... Currently, there are no established guidelines for the diagnosis or treatment of headache attributed to psychiatric disorder. Nonetheless, it is of supreme importance to systematically inquire about prior or ongoing physical, emotional, and/or sexual abuse. Emphasis is on the complex diagnostic process, the critical role of a multidisciplinary approach, and the consideration of the patients' emotional and social dimensions."

Cardiovascular • CNS Disorders • Depression • Dermatology • Fibromyalgia • Hypertension • Mental Retardation • Mood Disorders • Musculoskeletal Pain • Ophthalmology • Pain • Rheumatology

Comorbid migraine and epilepsy in a UK neurology tertiary service: Clinical characteristics, treatment outcomes, and prognosis (EHF-EHC 2025) - "Topiramate was prescribed in 23.9% of patients, and linked with poorer tolerability... In our tertiary comorbid migraine and epilepsy cohort, psychiatric comorbidity, treatment resistance in epilepsy and migraine as well as EEG abnormalities and intracranial lesions were present up to one in 5 of our cohort. Lack of structured outcome documentation limited retrospective evaluation, highlighting the need for standardised recording in comorbid populations."

Clinical • CNS Disorders • Depression • Epilepsy • Migraine • Mood Disorders • Pain