Case 1
A 27-year-old woman had a history of refractory complex
partial seizures since birth secondary to an hypothalamic
hematoma. She had no history of psychiatric
illness. Her seizure frequency was 1–2 per day
despite treatment with optimal doses of carbamazepineand lamotrigine. Topiramate was added to her regimen
beginning with 50 mg q.d. with a titration rate
of 50 mg every week. At a dose of 150 mg/day, she
had the sudden onset of paranoia with fear of being
observed and being followed all the time. Because of
this, the patient was afraid to leave her house. Other
side-effects included worsening unsteadiness of gait,
dizziness, and impairment of concentration and memory.
Her seizure frequency improved during treatment
with topiramate. The symptoms of paranoid ideation
resolved completely within 48 hours after discontinuation
of topiramate.