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Topiramate Used for Successful Treatment of Diabetic Peripheral Neuropathy: a Case Report

Oral topiramate may be an effective treatment for diabetic peripheral neuropathy, according to a recent case report from the University of Oklahoma, Tulsa, United States.

Painful diabetic neuropathies can be difficult to treat because of adverse medication effects and the development of tolerance. Topiramate is an anticonvulsant that is gaining acknowledgment in the treatment of neuropathic pain syndromes, but few data have been published on the use of this drug for diabetic peripheral neuropathy.

Kristina M. Kline, M.D., and colleagues have presented a case report of a patient with diabetic peripheral neuropathy who was successfully treated with oral topiramate.

The patient was a 47-year old, non-smoking, obese white woman who was diagnosed with diabetes 6 years earlier. She developed severe peripheral neuropathy 2 years after diagnosis, and an EMG revealed diffuse peripheral neuropathy consistent with diabetes and without lumbar nerve impairment.

The woman had fair control of her blood sugar on extended release glipizide 10 mg morning and 5 mg evening, rosiglitazone 4 mg BID, and metformin 1000 mg BID. She had tried gabapentin 1200 mg per day and ibuprofen 800 mg TID for treatment of peripheral neuropathy, but without improvement. Amitriptyline was also tried but discontinued due to adverse side effects. Symptoms continued to progress, and the patient eventually started using a walker.

Treatment was changed to topiramate 25 mg BID and the gabapentin and ibuprofen were stopped. She gradually improved and the topiramate was increased to 100 mg BID. It was, however, decreased back down to 25 mg BID because she was experiencing nervousness and sleep difficulties. The drug was then gradually increased back to 100 mg BID over the next several months.

"The patient experienced severe hypoglycaemic reactions after the topiramate was started, so she was taken off the glipizide and the rosiglitazone was decreased to 4 mg po QD. After 6 months of topiramate treatment, her blood glucose was increasing and the rosiglitazone was increased to 4 mg BID."

According to Dr. Kline, the patient has tolerated the topiramate well, her physical examination has remained stable, and her neuropathy has not progressed.

"Topiramate may be effective in the treatment of diabetic peripheral neuropathies, but randomised controlled trials will be needed," the researchers conclude.

"Dr. Kline cautions that topiramate must be titrated slowly to minimize adverse effects, and recommends that diabetic patients on this treatment should be counselled on the signs and effective management of hypoglycaemic pisodes."
South Med J 2003 Jun;96:6:602-5. "Painful diabetic peripheral neuropathy relieved with use of oral topiramate"

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