Patient/caregiver was instructed upon therapeutic uses and mechanism of action of topiramate as follows:
- Nerve impulses in the brain are transmitted from one cell to the other as mild electrical impulses.
- Many factors such as, neurotransmitters in the brain, sodium and glucose concentrations in the blood, bacterial infections, blood and oxygen supply to the brain, and mechanical injury to the brain play a significant role in influencing these nerve impulses in the brain.
- Some of these factors can act excitatory and some can act inhibitory to the nerve impulses in the brain. Excitatory factors can contribute to increased electrical discharge and nerve impulse transmission in the brain. Inhibitory factors can contribute to reduced electrical discharge and inhibition of nerve impulse transmission in the brain.
- Excitatory and inhibitory factors influencing the nerve impulse transmission in the brain are usually regulated in a fine balance. Disturbance to this fine balance due to any reason, favoring excitatory influence on the nerve impulse conduction in the brain, can result in excess electrical discharge in the brain, contributing to development of seizure activity.
- Gama-Aminobutyric acid (GABA) is an inhibitory neurotransmitter, acting on the GABA receptors in the brain, thus inhibiting the nerve impulses and reducing the electrical discharges in the brain. Also, Glutamic acid is an excitatory neurotransmitter, acting on the AMPA receptors in the brain, thus potentiating the nerve impulses and increasing the electrical discharges in the brain.
- Topiramate is an anticonvulsant medication, which increases the action of GABA and blocks the activity of glutamic acid on AMPA receptors.
- Topiramate, both by increasing activity of GABA and blocking the activity of glutamic acid, helps with reducing the excitation of nerve cells, controls the rapid firing of impulses, and blocks the excess electrical discharge, contributing to control of seizures.
- Due to the multiple modes of action in controlling the seizure activity, topiramate is considered a stronger anticonvulsant and so, can be used in individuals with seizures that are difficult to control with other medications.
- By controlling the excessive electrical discharge and nerve impulses in the brain, topiramate also helps to prevent migraine attacks and so, is used in migraine prophylaxis.
