Effect of topiramate and zonisamide on fMRI cognitive networks.

Abstract

OBJECTIVE:

To investigate the effects of topiramate (TPM), zonisamide (ZNS), and levetiracetam (LEV) on cognitive network activations in patients with focal epilepsy using an fMRI language task.

METHODS:

In a retrospective, cross-sectional study, we identified patients from our clinical database of verbal fluency fMRI studies who were treated with either TPM (n = 32) or ZNS (n = 51). We matched 62 patients for clinical measures who took LEV but not TPM or ZNS. We entered antiepileptic comedications as nuisance variables and compared out-of-scanner psychometric measures for verbal fluency and working memory between groups.

RESULTS:

Out-of-scanner psychometric data showed overall poorer performance for TPM compared to ZNS and LEV and poorer working memory performance in ZNS-treated patients compared to LEV-treated patients. We found common fMRI effects in patients taking ZNS and TPM, with decreased activations in cognitive frontal and parietal lobe networks compared to those taking LEV. Impaired deactivation was seen only with TPM.

CONCLUSIONS:

Our findings suggest that TPM and ZNS are associated with similar dysfunctions of frontal and parietal cognitive networks, which are associated with impaired performance. TPM is also associated with impaired attenuation of language-associated deactivation. These studies imply medication-specific effects on the functional neuroanatomy of language and working memory networks.

CLASSIFICATION OF EVIDENCE:

This study provides Class III evidence that in patients with focal epilepsy, TPM and ZNS compared to LEV lead to disruption of language and working memory networks.

• Authors: Britta Wandschneider, Jane Burdett, Lucy Townsend, Andrea Hill, Pamela J Thompson, John S Duncan, Matthias J Koepp
• Journal: Neurology (Neurology) Vol. 88 Issue 12 Pg. 1165-1171 (Mar 21 2017) ISSN: 1526-632X [Electronic] United States
• PMID: 28213372 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Chemical References

• Anticonvulsants
• Isoxazoles
• Topiramate
• Fructose
• Zonisamide
• Oxygen

Topics

• Adult
• Anticonvulsants (therapeutic use)
• Brain (diagnostic imaging, drug effects)
• Cognition Disorders (diagnostic imaging, drug therapy, etiology)
• Cross-Sectional Studies
• Epilepsies, Partial (complications, drug therapy)
• Female
• Fructose (analogs & derivatives, therapeutic use)
• Functional Laterality
• Humans
• Image Processing, Computer-Assisted
• Isoxazoles (therapeutic use)
• Language
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuropsychological Tests
• Oxygen (blood)
• Retrospective Studies
• Topiramate
• Zonisamide