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antiseizure

Topamax not working? Here’s a Possible Alternative

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Although Topamax (topiramate) has helped many patients, it is by no means the silver bullet to stop migraine.  It’s popularity has also been hampered by the side effects that some patients experience.

Of course there are many good alternatives to Topamax, but researchers are looking for something similar that will work for patients that are good candidates for something like topiramate, but who do not respond well to topiramate itself.

Zonegran - zonisamide

A study published in July (2014) investigated a drug called zonisamide as an alternative to topiramate.  In this case, patients with episodic migraine with aura were studied.  These were not patients who had severe reactions to topiramate, but who simply had not seen more than a 50% reduction of migraine attacks.

Zonisamide (sold as Zonegran)is another antiseizure drug.  Like Topamax, side effects are a common reason why patients do not continue with the treatment.  In fact, in this study 12% dropped out because of side effects such as dizziness, nausea, insomnia, and drowsiness.

In the end, however, there were two positive results.

First, many of the patients had much better success with zonisamide.  Over three months, every month things got better.

Second, side effects did actually seem to be less of a problem with zonisamide.  In particular, paresthesia (a tingling or burning feeling of the skin), one of the most common side effects in topiramate, was almost non-existent.

This is only a preliminary study.  It was open label (meaning the patients knew what they were taking), and patients directly switched to a steady dose of zonisamide (100mg/day taken in two doses).  It will be interesting to see how patients respond to different doses.

One other interesting note – some patients dropped out because they improved very quickly and decided they didn’t need more treatment!  That sounds great, although it’s too bad they didn’t understand the value of continuing the study so that the results can be measured.

Zonisamide has not been approved as a migraine medication, but this study shows that it is worth studying as an alternative preventative to Topamax.  If you’ve tried it, leave a comment and let us know how it worked for you.

Sources:
Efficacy of Zonisamide in Migraineurs with Nonresponse to Topiramate
Zonegran (Drugs.com)

Anti-seizure meds and Suicide

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Anti seizure meds are back in the news after the The US Food and Drug Administration (FDA) reported on its analysis of almost 200 studies on various drugs.  The question was – are people on antiseizure medication at more risk of suicidal thoughts?

This is an important question particularly for migraine sufferers, for a couple of reasons.  First, many migraineurs are on these drugs as a treatment for migraine.  They include drugs like Depakote (divalproex sodium), Neurontin (gabapentin), Lamictal (lamotrigine), Keppra (levetiracetam), and of course Topamax (topiramate).

To add to the issue, depression is comorbid with migraine, meaning that people often have both issues at the same time.

Suicide warnings on antiseizure medication

The FDA finally concluded that there was a risk of increased suicidal thoughts for people taking these and related medications (21 medications in all).  They decided that a new warning label will be required for these medications.  That decision was followed in Europe, and the data is currently under review in Canada.

The decision to change warning labels has been controversial.  It’s natural that there would be controversy where money is involved.  Seizure medication sold to the tune of $10 billion in the United States alone in 2007.

But money isn’t the only issue.  Doctors are concerned that the news is confusing patients, and they’re afraid some patients will stop taking their medication.

The risk for suicide is really very small, they say, compared to the risks of not having the medication at all.

These labels are often so arbitrary.  For example, in 2007 psychiatrists convinced the FDA to scale back language on labels of antidepressants, because some patients got worried and stopped taking the medication.

What’s the answer?  What you’re doing right now – we as patients need to be educated on the issues.

There’s almost no chance that taking antiseizure medication alone will cause you to commit suicide.  The warning in the US will be that "about 1 in 500 patients face an increased risk of suicidal thoughts and behavior".

However, if you do suffer from depression, be aware that the drug could, in rare cases, make it worse.  Discuss this with your doctor, and be sure she knows your medical history.

Do not just stop taking your medication without talking it over with your doctor.

Medications have helped many with migraine.  But we need to use them knowledgeably, with caution, and with the counsel of a doctor.

For more, read U.S. orders suicidal action warning on epilepsy drugs from the UK, and FDA adds suicide warning to epilepsy drugs

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