From the Research
Topiramate can cause involuntary movements during sleep, specifically myoclonus and restless leg syndrome, as a side effect, and the best management is probably the discontinuation of the medication, as evidenced by a case series and literature review published in 2020 1. The exact cause of these movements is not fully understood, but it is thought to be related to topiramate's effects on GABA and glutamate neurotransmission in the brain, which regulate motor control during sleep. Some key points to consider when managing topiramate-induced involuntary movements during sleep include:
- The mean time of onset of these movements is approximately 1.37 months after starting the medication, and the mean time of recovery is approximately 1.02 months after discontinuation 1.
- The mean dose of topiramate associated with these movements is approximately 87.5 mg per day 1.
- Discontinuation of topiramate is often effective in resolving the movements, but in some cases, addition of a dopaminergic agonist may be beneficial, particularly for patients with restless leg syndrome 1.
- It is essential to contact a healthcare provider promptly if experiencing these symptoms, rather than stopping the medication abruptly, to discuss the best course of action and potential alternative treatments, such as lamotrigine, levetiracetam, or valproate 1.