topiramate (USL255 / Qudexy XR)

Acute catatonia and psychosis in the context of seizure exacerbation in epilepsy: a case report.

Alowais Maryam M, Khan Zainab Z, Salamah Fares F, Khalil Dania D et al.

The co-occurrence of seizure-associated psychosis and catatonia in epilepsy is diagnostically challenging, particularly when complex pre-existing psychiatric comorbidities complicate attribution. Few reports describe this triad in the context of an antidepressant switch. We report a 44-year-old woman with a 27-year history of epilepsy, maintained on carbamazepine and topiramate, and a longstanding psychiatric history of major depressive disorder, obsessive-compulsive symptoms, and chronic nihilistic delusions and intermittent hallucinations documented at baseline. One week before admission, her antidepressant was switched from clomipramine to venlafaxine 150 mg/day. Her caregiver reported increased seizure frequency, culminating in a breakthrough seizure 48 hours before presentation. She then developed acute mutism, food refusal, and unresponsiveness. On admission she met DSM-5-TR criteria for catatonia (mutism, stupor, posturing, waxy flexibility), which gradually resolved over the admission. Electroencephalography under sedation following benzodiazepine administration showed no epileptiform activity, though sensitivity for non-convulsive status epilepticus was limited. Electrocardiography demonstrated QTc prolongation (497 ms). Once verbal, the patient reported persecutory and nihilistic delusions, derealization, and auditory hallucinations. Management with escalating benzodiazepines and cautious antipsychotic uptitration (quetiapine XR, cariprazine) was associated with complete catatonic remission and psychotic symptom resolution over 29 days. This case illustrates the diagnostic uncertainty inherent in attributing acute psychiatric features to seizure activity when complex pre-existing psychiatric histories exist. The absence of a documented lucid interval and the presence of chronic baseline psychotic symptoms preclude a confident diagnosis of postictal psychosis; interictal psychosis or primary psychiatric disorder cannot be excluded. The case highlights underrecognized pharmacokinetic interactions between carbamazepine (a potent CYP3A4 inducer) and second-generation antipsychotics, and cardiac safety considerations during antipsychotic uptitration with QTc prolongation. The working discharge diagnosis was catatonic disorder due to another medical condition (epilepsy), with psychotic features of indeterminate classification. Clinicians should resist anchoring on temporal associations between seizure activity and psychiatric symptoms. EEG findings must be interpreted in their pharmacological context; pharmacokinetic interactions should inform antipsychotic dose selection; and QTc prolongation warrants structured cardiac monitoring.

Optic nerve head swelling and acute glaucoma induced by topiramate.

Khataei Sanam S, Black Daniel Ovid DO, Toren Andrew A

Cognitive Side Effects of Antiseizure Medications in Adults with Epilepsy: An Update with a Focus on New Therapeutic Agents.

Mula Marco M

Antiseizure medications (ASMs) are the mainstay of epilepsy treatment but may adversely affect cognitive functions, deepening the cognitive and psychosocial burden intrinsic to epilepsy. Cognitive side effects vary widely across drug classes, doses, treatment regimens, and individual susceptibility, typically affecting attention, processing speed, memory, language, and executive function. This narrative review provides an updated synthesis of the clinical evidence on the cognitive effects of ASMs, mostly in adults, building on a prior 2009 review and focusing on agents introduced into clinical practice since then. A literature search of PubMed identified studies published between January 2009 and December 2025, yielding data from randomised controlled trials, observational studies, meta-analyses, and systematic reviews. Overall, newer-generation ASMs, including rufinamide, lacosamide, brivaracetam, cannabidiol, fenfluramine, and ganaxolone, demonstrate generally favourable cognitive profiles when used at recommended doses, particularly in monotherapy or rational polytherapy. Eslicarbazepine and cenobamate may be associated with mild, dose-dependent cognitive effects, occurring only at the upper end of the recommended dose range. In contrast, old ASMs and certain second-generation agents, notably topiramate and zonisamide, remain consistently associated with higher cognitive risks. Special populations, including older adults and individuals with intellectual disabilities, are particularly vulnerable to cognitive adverse effects and benefit from agents with low interaction potential and benign neuropsychological profiles. Cognitive dysfunction in epilepsy is multifactorial, reflecting the interaction between disease-related neurobiological mechanisms and treatment effects. Optimal management requires balancing seizure control with cognitive preservation through individualised drug selection, cautious titration, and minimisation of polytherapy to achieve the best functional and quality-of-life outcomes.

Pharmacological management of obesity: Current landscape and emerging therapies.

Atal Shubham S, Agrawal Chirag C, Gupta Rahul R, Sadasivam Balakrishnan B

Obesity is now recognized as a chronic, multifactorial, and progressive disease as opposed to mere excess of body weight. It significantly increases the risk of type 2 diabetes, cardiovascular disease, metabolic-associated fatty liver disease, and mental health disorders. 2022 data reveal that nearly 3 billion individuals worldwide were living with either obesity or overweight. Pharmacological therapy has evolved remarkably. Earlier medications targeted primarily the brain's monoaminergic pathways but they were withdrawn due to safety concerns. Currently, six medications (Orlistat, Phentermine/Topiramate, Naltrexone/Bupropion, Liraglutide, Semaglutide, and Tirzepatide) are approved by the U.S. Food and Drug Administration for long-term obesity management and among these, glucagon-like peptide receptor agonists have revolutionized the therapy. The emerging pipeline is even more promising. It has new dual and triple combinations such as CagriSema, Survodutide, and Retatrutide for better efficacy and metabolic outcomes, as well as long-acting and oral formulations, which will improve adherence and accessibility. India released its new obesity guideline in January 2025, emphasizing on early pharmacotherapy initiation and the adoption of stage-based obesity classification. Together, these developments signify a transformative era in obesity care where pharmacotherapy is a powerful and evidence-based tool that, in many cases, approaches the efficacy and metabolic benefits traditionally associated with bariatric surgeries.