Randomized clinical trial of topiramate for levodopa-induced dyskinesia in Parkinson's disease

Parkinsonism Relat Disord. 2014 Jan 28. pii: S1353-8020(14)00031-5. doi: 10.1016/j.parkreldis.2014.01.016. [Epub ahead of print]

Kobylecki C, Burn DJ, Kass-Iliyya L, Kellett MW, Crossman AR, Silverdale MA.

Abstract

BACKGROUND:

The antiepileptic drug topiramate reduces levodopa-induced dyskinesia without exacerbating parkinsonism in animal models. We report a randomized, double-blind, placebo-controlled crossover trial in patients with Parkinson's disease and levodopa-induced dyskinesia.

METHODS:

Fifteen patients with Parkinson's disease and stable levodopa-induced dyskinesia were enrolled into the study, of whom 13 were randomized to topiramate or placebo. The study medication was titrated to 100 mg/day over four weeks, and assessments were carried out after a further two weeks. Dyskinesia severity assessed by a blinded rater from video recordings was the primary outcome measure.

RESULTS:

Seven patients (mean age 58.9 ± 12.8 years) completed the study. Patients taking topiramate vs. placebo showed a significant increase in dyskinesia severity compared to baseline (Wilcoxon signed rank test, P = 0.043). Five patients withdrew from the study whilst taking topiramate due to adverse effects.

CONCLUSIONS:

Topiramate tended to worsen dyskinesia in patients with Parkinson's disease, and was poorly tolerated.