topiramate / Generic mfg. - LARVOL DELTA

Changes in complete blood count (CBC) and white blood cell (WBC) differential associated with overweight and obesity: A patient-level meta-analysis of randomized trials (ASH 2025) - " Individual patient data were obtained from five randomized, double-blind, placebo-controlledtrials of topiramate in overweight and obese adults from the Yale University Open Data Access program(YODA)... A total of 2,904 overweight and obese individuals (BMI range 26.5-51.4 kg/m²) had availablehematologic data at enrolment. The cohort included 650 (22.4%) males and 2,254 (77.6%) females with amean age of 46 (±11) years. Racial distribution was 2,764 (95.18%) White, 107 (3.68%) Black, 17 (0.59%)Asian, and 16 (0.55%) other."

Retrospective data • Genetic Disorders • Hematological Disorders • Obesity • Thrombocytosis • TINCR

Lacosamide versus topiramate in episodic migraine: a randomized controlled double-blinded trial. (PubMed, Ther Adv Neurol Disord) - P3 | "Lacosamide was more tolerable than topiramate in episodic migraine patients. Prospectively registered on clinicaltrials.gov, NCT06243692-January 29, 2024; https://clinicaltrials.gov/study/NCT06243692."

Journal • CNS Disorders • Epilepsy • Migraine • Pain • CRMP

Quality of life and synergistic combinations of antiseizure medication in patients treated with cenobamate in early therapy lines for focal-onset seizures. (PubMed, Epilepsy Behav) - "Our study provides evidence that CNB in early therapy lines for focal-onset seizures is associated with an increased HrQoL. Low-dose clobazam can wok synergistically with CNB. The combination with SV2A modulators showed a positive trend."

HEOR • Journal • CNS Disorders • Epilepsy

Prenatal Exposure to Antiseizure Medications and the Risk of Congenital Anomalies: A Nationwide Population-Based Study in South Korea. (PubMed, Neurology) - "This study revealed that prenatal exposure to valproate increased the risk of congenital anomalies. Although other ASMs, even in polytherapy, did not significantly increase the overall risk of congenital anomalies, carbamazepine, levetiracetam, oxcarbazepine, and topiramate were associated with specific types of congenital anomalies. Given the limited number of cases, these findings warrant further investigation in other populations."

Journal • Retrospective data • CNS Disorders • Epilepsy • Ventriculomegaly

Pharmacokinetics and Pharmacodynamics of Topiramate for Weight Loss in Youth: PHARMATOP (clinicaltrials.gov) - P1 | N=65 | Active, not recruiting | Sponsor: University of Minnesota | Trial completion date: Nov 2025 ➔ Mar 2026

Trial completion date • Genetic Disorders • Obesity

Topiramate-Induced Bilateral Acute Angle Closure in a Healthy Young Female. (PubMed, Cureus) - "This case underscores that cycloplegia and drug cessation are the key interventions, while LPI may be performed only when the underlying mechanism is unclear. This case highlights the importance of recognizing medication-induced angle closure and distinguishing it from primary pupillary-block mechanisms to ensure timely, vision-saving management."

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

The impact of preoperative antiobesity medications on weight loss in adolescents undergoing metabolic and bariatric surgery - a COSMIC study. (PubMed, Surg Obes Relat Dis) - "Preoperative exposure to topiramate or GLP-1RA was associated with less postoperative weight loss, despite similar starting weights/BMIs. Total weight loss from consultation through 12 months did not differ significantly between groups. These findings raise important questions regarding the use and timing of obesity management medications in relation to surgery for adolescents."

Journal • Genetic Disorders • Obesity • Pediatrics

Epigenetics in migraine: the junior editorial board members' vision. (PubMed, J Headache Pain) - "The role of epigenetic modifications of genes involved in the CGRP pathway, synaptic plasticity and TRPV1, TRPA1 and estrogen receptor signaling in migraine is emerging. Therefore, a deeper understanding of the impact of epigenetics in migraine pathophysiology and neuropharmacology is needed to revert chronification and personalize medicine in the field of migraine, improving efficacy and safety of treatments and widening the therapeutic armamentarium."

Journal • Review • CNS Disorders • Migraine • Pain • Pediatrics • ANK1 • ER • TRPA1 • TRPV1

Pharmacologic neuroprotective agents for the treatment of perinatal asphyxia in low-income and lower-middle-income countries: A systematic review and meta-analysis of randomised controlled trials. (PubMed, PLoS One) - "Pharmacologic neuroprotective agents show promise in improving survival and neurological outcomes in neonates with PA in LILMICs. However, more robust, multi-center RCTs are needed to confirm their efficacy and establish them as feasible alternatives to therapeutic hypothermia in these settings."

Clinical • Journal • Retrospective data • Review

Pharmacological interventions to manage cardiometabolic outcomes in adults with severe mental illness: umbrella review. (PubMed, Br J Psychiatry) - "Pharmacological interventions can improve cardiometabolic outcomes in adults with SMI when non-pharmacological interventions are either insufficient alone, impractical or unacceptable. However, licensed treatments have been reviewed in relatively low numbers. Improving cardiometabolic outcomes is a key area in psychiatry, and the results of this review will be important in shaping future guidance."

Journal • CNS Disorders • Dyslipidemia • Psychiatry • Tobacco Cessation

Evaluating agreement between physician and ChatGPT in migraine prophylaxis selection: A pilot comparative study (EHF-EHC 2025) - "To evaluate the level of agreement between human clinicians and an artificial intelligence (AI) model (ChatGPT) in recommending first-line prophylactic therapies for patients with migraine, and to assess the potential clinical value of AI-generated support.In this observational pilot study, we analyzed 21 consecutive patients with a confirmed diagnosis of episodic migraine evaluated at a pain clinic.For each patient, the treating clinician selected a first-line preventive treatment among four options: amitriptyline, propranolol, topiramate or flunarizine. This pilot study demonstrates that ChatGPT can produce clinically coherent prophylactic treatment proposals in the management of migraine, with a statistically significant moderate agreement with experienced pain physicians. Further validation on larger cohorts is warranted to explore its potential as a clinical decision support tool."

CNS Disorders • Migraine • 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

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

The influence of blood pressure on susceptibility to spreading depolarization (EHF-EHC 2025) - "To examine the interplay between migraine susceptibility and chronic modulation of BP, both SHR and WKY rats were treated for three weeks with agents of distinct clinical profiles: amlodipine (antihypertension+; migraine prevention-), topiramate (migraine prevention+; antihypertension-), and candesartan (migraine prevention+; antihypertension+). Our findings highlight a link between BP and cortical excitability, which may mediate the clinical association between hypertension and increased migraine susceptibility. Modulating BP may reduce SD susceptibility, suggesting that optimizing BP control in patients with migraine may contribute to improved therapeutic outcomes, particularly in individuals with comorbid hypertension."

Cardiovascular • CNS Disorders • Hypertension • Migraine

Post-migraine hemorrhagic manifestations: Evidence from two clinical cases (EHF-EHC 2025) - "The first is a 42-year-old woman with chronic migraine since age 36, on propranolol 40mg/day...After starting a continuous progesterone-only pill in May, both headaches and bruising completely resolved. The second is a 40-year-old woman with episodic migraine since age 30, on topiramate 100mg/day...The link between attacks and bleeding, along with improvement following hormonal or neural interventions, suggests a possible interplay between neurovascular dysregulation, hormonal modulation and peripheral tissue response. Greater clinical awareness of these manifestations may enhance diagnostic and therapeutic approaches in migraine care."

Clinical • CNS Disorders • Hematological Disorders • Inflammation • Migraine • Pain

Clinical-genotype machine prescription for migraine – A HUNT study (EHF-EHC 2025) - "In total, 475 participants tried a preventive (amitriptyline, beta-blocker, candesartan or topiramate) and 565 a triptan (371 sumatriptan) during the project period. Figure 1 . SHAP bar blot of ten most important clinical features across all four preventive models"

Clinical • CNS Disorders • Migraine • Pain

Preventive migraine care before headache clinical referral: Are we doing it right? (EHF-EHC 2025) - "Commonly prescribed agents in primary care shifted from propranolol and amitriptyline in 2017 to topiramate and amitriptyline in 2023. Our findings suggest a clear evolution toward more appropriate and guideline-informed referral practices. Primary care providers are increasingly initiating preventive therapy before seeking specialist input."

Clinical • CNS Disorders • Migraine • Pain

Efficacy and safety of valproate versus topiramate in migraine prophylaxis: A systematic review and meta-analysis (EHF-EHC 2025) - "Topiramate and valproate demonstrated comparable efficacy in migraine prophylaxis, though topiramate was associated with greater reduction in migraine frequency. Safety profiles differed, with more hair loss reported with valproate and more weight loss with topiramate."

Retrospective data • Review • Alopecia • CNS Disorders • Cognitive Disorders • Migraine • Movement Disorders • Pain

Therapeutic challenges in a rare trigeminal autonomic cephalalgia (EHF-EHC 2025) - "A discrete improvement was noted with intravenous eptinezumab 300 mg every 12 weeks, in combination with duloxetine, gabapentin, topiramate and tapentadol. He makes excessive use of fast-acting tramadol and ibuprofen to alleviate acute pain...SUNCT remains a therapeutic challenge due to its rarity, limited evidence base, and frequent refractoriness. This reinforces the need for further research and therapeutic innovation."

Rheumatology

Acute confusional migraine in adults – A case report (EHF-EHC 2025) - "Diazepam, haloperidol, and chlorpromazine were administered, but agitation persisted...Lumbar puncture was performed, and empiric antibiotics plus acyclovir were started but discontinued within hours after normal CSF and negative viral PCR...Although self-limiting, no abortive treatment is available; however, valproic acid and topiramate may be used to treat and prevent recurrences. The absence of formal criteria and the diagnosis being one of exclusion hinder clinical recognition."

Case report • Clinical • Cardiovascular • CNS Disorders • Hypertension • Migraine • Pain

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

Comparative efficacy and safety of topiramate versus flunarizine in migraine prophylaxis: A systematic review and meta-analysis (EHF-EHC 2025) - "Safety profiles were broadly similar, except that the topiramate group demonstrated higher incidences of paresthesia. Future RCTs should include larger sample sizes and use standardized reporting frameworks, including a core outcome set, to ensure consistency across studies and allow for more definitive and generalizable conclusions."

Retrospective data • Review • CNS Disorders • Migraine • Pain

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...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

Assessing the effectiveness of personalized migraine treatment – A 22-year N-of-1 study (EHF-EHC 2025) - "No significant adverse effects were reported Topiramate (2006) was ineffective (+8.3% headache days); amitriptyline (2008) increased headache days (+20.4%) but reduced zolmitriptan use (−37.7%)...Erenumab (2020–2021) worsened both metrics (+4.1%, +37.8%). Flunarizine (2023) had modest benefit (−17%), and oxitriptan (2023–2024) had minimal effect. Despite long-term triptan overuse, the patient never developed medication-overuse headache, and zolmitriptan remained effective throughout We report a case of chronic refractory migraine with long-term triptan overuse but without evidence of medication-overuse headache. This case raises the question of whether pharmacological resistance to preventives may be linked to preserved responsiveness to acute treatments"

CNS Disorders • Migraine • Mood Disorders • Obsessive-Compulsive Disorder • Pain • Personality Disorder

Treatment pattern and reasons for discontinuing preventive treatment in cluster headache: A prospective cohort study (EHF-EHC 2025) - "Proportionally, the second-line treatments with lithium or topiramate were discontinued due to intolerance in nearly half of the patients. Effective therapeutic prevention of cluster headache is hindered by intolerance and insufficient efficacy of the preventatives. Verapamil remains effective over time for a subgroup of initial responders, but our findings underscore the need for more tolerable and effective prophylactic medicine in the treatment of cluster headache."

Clinical • Pain • Preventive care