Heathcare providers prescribe Topamax for the treatment of epilepsy, or various seizure disorders, including Lennox-Gastaut syndrome, and the prevention of migraine headaches as approved by the U.S. Food and Drug Administration. Healthcare providers also prescribe Topamax off-label for mood-stabilization for bipolar disorders according to Dr. C. Thomas Gualtieri and Lynda G. Johnson, Ph.D., in the study published in the August 23, 2006 issue of "Medscape General Medicine."
Lamotrigine
The U.S. Food and Drug Administration approved lamotrigine for the treatment of seizure disorders including Lennox-Gastaut syndrome. These indications are the same as Topamax, except lamotrigine does not have an indication for the prevention of migraine headaches, as does Topamax. Heathcare providers may use lamotrigine alone or in combination with other medication used to treat seizure disorders. Prescribers adjust the dose of lamotrigine when combined with certain medications. According to Dr. Joseph I. Sirven in the 2002 issue of "Mayo Clinic Proceedings", when prescribed with phenobarbitol, phenytoin or carbamazepine, the prescriber must increase the dose of lamotrigine to provide efficacy and prevent breakthrough seizures. Sirven also reports that prescribers lower the dose of lamotrigine when prescribed concomitantly with valporic acid. Gualtieri and Johnson report that, of the various psychotropic anticonvulsants, lamotrigine achieves mood stabilization in psychiatric disorders most effectively while remaining well tolerated. The article also reports that cognitive impairments are less likely with lamotirgine than with other psychotropic anticonvulsants. Gualtieri and Johnson report that Topamax also stabilizes the mood, but is more likely than the other psychotropic anticonvulsants to cause cognitive problems, and lamotrigine the least likely.
Oxcarbazapine
The U.S. Food and Drug Administration also approved oxcarbazapine for the treatment of seizure disorders, but it does not have an indication for the prevention of migraine headaches, as does Topamax. Healthcare providers may prescribe oxcarbazapine alone or in combination with other anticonvulsants for the treatment of certain seizure disorders, but it does not have an indication for Lennox-Gastaut syndrome, as does Topamax and lamotrigine. Gaultieri and Johnson report a lower side effect profile for oxcarbazapine, similar to that of lamotrigine. Both medications are less likely to cause the cognitive problems that may be experienced with Topamax, according to the same report.
Gabapentin
Healthcare providers most commonly prescribe gabapentin in combination with other anticonvulsants, as opposed to using it alone, for the treatment of seizure disorders according to Sirven. Sirven also reports that gabapentin does not have an official approval by the U.S. Food and Drug Administration for the prevention of migraine headaches, as does Topamax, but is used off-label for this purpose. Drs. Richard J. Stark and Catherine D. Stark report in an article in the September 1, 2008 issue of "The Medical Journal of Australia," that a study using gabapentin for the prevention of migraine headaches showed 26 of 56 cases had a 50 percent reduction in headaches after four weeks of treatment.
References
- "Medscape General medicine"; Comparative Neurocognitive Effects of 5 Psychotropic Anticonvulsants and Lithium; C. Thomas Gualtieri; 2006
- "Mayo Clinic Proceedings"; Antiepileptic Drug Therapy for Adults: When to Initiate and How to Choose; Joseph I. Sirven; Dec 2002
- "Medical Journal of Australia";Migraine Prophylaxis"; Richard J. Stark; Sept 2008
