RESUMEN
OBJECTIVE: To evaluate the efficacy of topiramate in the preventative treatment of episodic migraine. BACKGROUND: Topiramate is a broad-spectrum antiepileptic drug effective for treatment of multiple seizure types in adults and children. Antiepileptic agents have demonstrated efficacy in migraine prevention, and open-label experience from our clinic has suggested that topiramate might be effective for this use. We consequently conducted a single-center, double-blind, placebo-controlled trial to evaluate the efficacy and safety of topiramate for the preventative treatment of migraine. METHODS: Forty patients, aged 19 to 62 years (mean, 38.2 years), were randomly assigned in a 1:1 ratio to receive topiramate (n = 19; all women) or placebo (n = 21; 20 women, 1 man). Following a prospective baseline phase of 4 weeks, the study drug dose was titrated weekly in 25-mg increments over 8 weeks to 200 mg per day or to the maximum tolerated dose. The titration phase was followed by an 8-week maintenance phase. RESULTS: During the entire double-blind phase, topiramate-treated patients experienced a significantly lower 28-day migraine frequency (3.31 +/- 1.7 versus 3.83 +/- 2.1; P =.002) compared to placebo, irrespective of use of concomitant migraine prevention medications. The mean 28-day migraine frequency was reduced by 36% in patients receiving topiramate as compared with 14% in patients receiving placebo (P =.004). Twenty-six percent of the patients on topiramate and 9.5% of the patients on placebo achieved a 50% reduction in migraine frequency (P >.05). The mean dose of topiramate was 125 mg per day (range, 25 to 200 mg per day). Topiramate was well tolerated; 2 of 19 topiramate-treated patients discontinued treatment due to adverse events. Adverse effects that occurred more frequently in topiramate-treated patients included paresthesia, weight loss, altered taste, anorexia, and memory impairment. CONCLUSIONS: Preventative therapy with topiramate significantly reduced migraine frequency. Larger multicenter clinical studies may further delineate the role of topiramate in migraine prevention.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Fructosa/uso terapéutico , Trastornos Migrañosos/prevención & control , Adolescente , Adulto , Anciano , Analgésicos/administración & dosificación , Anorexia/inducido químicamente , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/farmacología , Peso Corporal/efectos de los fármacos , Método Doble Ciego , Combinación de Medicamentos , Disgeusia/inducido químicamente , Femenino , Fructosa/efectos adversos , Fructosa/análogos & derivados , Fructosa/farmacología , Humanos , Masculino , Trastornos de la Memoria/inducido químicamente , Persona de Mediana Edad , Parestesia/inducido químicamente , Topiramato , Resultado del Tratamiento , Pérdida de Peso/efectos de los fármacosRESUMEN
It is well established that two-kidney, one clip renovascular hypertension can be rapidly reversed by unclipping. We hypothesized that rapid renal reperfusion and the subsequent fall in blood pressure are mediated in part by nitric oxide, the endothelium-derived relaxing factor. We tested whether the hypotensive response to unclipping could be blocked by nitric oxide synthesis inhibition using a bolus of 10 mg/kg body wt N omega-nitro-L-arginine methyl ester. Rats were made hypertensive by placing a silver clip on the left renal artery. After 4 weeks, they were anesthetized and either not treated (controls) or had nitric oxide synthesis blockade. After 10 minutes, the clip was removed and blood pressure monitored over 60 minutes. Initial pressure in controls was 157 +/- 8 mm Hg, and heart rate was 310 +/- 21 beats per minute. Unclipping resulted in pressure falling to 125 +/- 6 mm Hg within 45 minutes (P < .005). Heart rate was unchanged (312 +/- 9 beats per minute). In contrast, nitric oxide synthesis inhibition increased blood pressure from 149 +/- 6 to 174 +/- 9 mm Hg (P < .001). Unclipping did not change blood pressure, which was 167 +/- 8 mm Hg after 60 minutes (P < .005 versus controls), and heart rate remained unchanged (282 +/- 13 versus 276 +/- 16 beats per minute). We determined the blood flow to the clipped kidneys using radioactive microspheres. Unclipping untreated hypertensive rats resulted in a 10-fold increase in renal blood flow (P < .001), concomitant with a decrease in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)