Turkish Neurosurgery 2014 , Vol 24 , Num 5
The Effects of Topiramate Therapy on Cerebral Metabolism in Migraine with Aura Patients
Omer KARADAS1, Hakan Levent GUL2, Bilgin OZTURK3, Erdal EROGLU3, Seref DEMIRKAYA3
1Erzincan Military Hospital, Neurology Service, Erzincan, Turkey
2Kartal Education and Research Hospital, Department of Neurology, Istanbul, Turkey
3Gulhane Military Medical Academy, Department of Neurology, Ankara, Turkey
DOI : 10.5137/1019-5149.JTN.9059-13.1 AIM: Topiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment.

MATERIAL and METHODS: We included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.

RESULTS: Basal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05).

CONCUSION: Topiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control. Keywords : Migraine, Topiramate, Cerebral vasomotor reactivity, Preventive treatment, Transcranial doppler

Corresponding author : Hakan Levent Gul, leventgul2003@yahoo.com