A 46-year-old man had a 12-year history of posttraumatic
complex partial seizures. He had no history
of psychiatric illness. His seizure frequency was one
per month on no antiepileptic medication. Topiramate
was begun at a dose of 50 mg q.d. with a titration
rate of 50 mg increase each week. Symptoms of psychosis
developed at a topiramate dose of 75 mg b.i.d.
(150 mg/day). He had recurrent thoughts and voices
urging him to yell at people and slap his wife. Other
symptoms consisted of sudden onset of severe, violent
and hostile moods, agitation and feeling that he was
another person. He also experienced excessive sedation,
restlessness, confusion and fear. These symptoms
resolved completely within 48 hours after discontinuation
of topiramate.