Several lines of scientific evidence showed that
topiramate may induce psychotic symptoms when used as monotherapy. It has been postulated that this
topiramate effect may be caused by the inhibition of frontal and prefrontal areas induced by
topiramate. The clinical history of the patient described shows that
topiramate may also induce
psychosis when used in polytherapy. A 34-year-old man, with
epilepsy associated to
tuberous sclerosis complex and without a previous history of
mental disorders, presented an acute onset of florid psychotic symptoms, including visual and
auditory hallucinations, derealization, and depersonalization. These symptoms appeared 1 month after the introduction of
topiramate, added to
levetiracetam and
carbamazepine, when
topiramate reached the dose of 200 mg daily. Once
topiramate was discontinued, the psychotic symptoms disappeared, with no recurrence in a 4-month follow-up. Psychotic symptoms were associated with
topiramate administration. We hypothesized that psychotic symptoms appeared a month after the
topiramate introduction because of the slow
topiramate titration and protective effect of
carbamazepine.