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Topiramate – Cognitive Side Effects — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersTopiramate – Cognitive Side EffectsSCE Neurology

A 45-year-old woman with known epilepsy on topiramate reports cognitive slowing, word-finding difficulty, and reduced concentration. These symptoms began after starting topiramate and worsen with dose increases. What is the mechanism of topiramate's cognitive side effects?

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Correct answer: E — Topiramate causes dose-dependent cognitive impairment (particularly word-finding difficulty, reduced verbal fluency, and psychomotor slowing) — the mechanism involves carbonic anhydrase inhibition, GABA enhancement, and glutamate antagonism affecting cortical processing

Topiramate is one of the AEDs most associated with cognitive side effects: word-finding difficulty (anomia), reduced verbal fluency, psychomotor slowing, and concentration problems. These are dose-dependent and often the reason for discontinuation. The mechanism involves multiple pharmacological actions affecting cortical function. NICE NG217 advises counselling patients about these risks. Cognitive effects are more pronounced at higher doses and with rapid titration. A: Cognitive effects are well-documented and common. C: Topiramate causes weight LOSS, not gain. D: Effects are dose-dependent. E: Multiple AEDs affect cognition.

Reference: BNF – Topiramate; NICE NG217