Topiramate-induced persisting perception disorder

Evans (2006) reported 2 patients aged 57 and 43, respectiely, who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses, but recurred or increased in frequency or duration on higher doses. Both patients showed full remission of palinopsia when the drug was discontinued. Fontenelle (2008) observed a 35-year-old patient with psychiatric disorder who developed palinopsia (described by her as seeing of "frozen pictures" of moving objects, "picture in picture" images, like she was in a "discotheque" or in a place with stroboscopic lights, reminiscent of a variety of cinematographic vision) soon after the increase of topiramate to 100 mg/day. Although this phenomenon occurred several times during a day, it didn't bother her and she preferred not to discontinue the medication (i.e., it can be assumed that the palinopsia had a duration > 7 days in this case, although the author didn't specify its duration). In conclusion, the 3 case reports suggest that topiramate use may cause palinopsia through an unknown mechanism in both migraineurs and non-migraineurs.

References

Evans RW. Reversible palinopsia and the Alice in Wonderland syndrome associated with topiramate use in migraineurs. Headache 2006; 46: 815-818.
Fontenelle LF. Topiramate-induced palinopsia. J Neuropsychiatry Clin Neurosci 2008; 20: 249-250.

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