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Effects of topiramate on cognition
  1. K J MEADOR
  1. Medical College of Georgia
  2. 1120 15th Street (BA 3410)
  3. Augusta, GA 30912, USA
  1. Professor K J Meador KMEADOR{at}NEURO.MCG.EDU

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This letter concerns the recently published study by Thompsonet al,1 reporting the authors' findings on cognitive effects with topiramate. Firstly, I want to correct the authors' mischaracterisation of a review paper of mine. The authors state that “the literature on antiepileptic drugs ... emphasised positive psychotropic effects,” referencing only a 1998 review in which I discussed cognitive and psychotropic effects of antiepileptic drugs. Although I mention some positive effects, I also discussed negative effects, including studies from my own centre that have shown significant negative psychotropic and cognitive drug effects.

Secondly, I provide some perspective on the report of Thompsonet al of clinically significant cognitive declines in 18 patients treated with topiramate as adjunctive therapy. The authors correctly conclude that “caution is warranted in the interpretation of the findings due to methodological limitations of the study design.” Because their study was retrospective and observational, it is susceptible to considerable subject selection bias. For example, five of the 18 patients were specifically included in the topiramate sample because they reported cognitive effects.

The only way to minimise effects that may bias …

Dr P J Thompson

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