Case 2
A 62-year-old woman had a history of complex partial
seizures since five years of age. She had no history
of psychiatric illness. She had been seizure-free
for 2.5 years on phenytoin before a seizure two days
before topiramate was introduced. Topiramate was begun
at 25 mg q.d. and increased at a rate of 25 mg
each week for the first four weeks. Symptoms of psychosis
and paranoia developed at a dose of 150mgb.i.d.
(300 mg/day). These consisted of remaining awake all
night hearing voices, and accusing her husband of attempting
to kill her. She repeatedly complained of intruders
within the house. Six weeks after the introduction
of topiramate she developed onset of psychotic
symptoms while she continued to be seizure-free during
this period. Resolution of symptoms was seen with
reduction of the topiramate dose to 100 mg twice a
day (200 mg/day), and she was continued on topiramate.