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• W2980706997 abstract "SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Migraine headaches are a common condition affecting about 12% of the general population, more common in women (17%) than men (6%) [1]. Migraine patients can benefit from a number of preventive drugs such as propranolol, valproate, and topiramate. Data suggests that topiramate is as effective as propranolol for migraine prevention and may be more beneficial than valproate. Among the many adverse effects of topiramate, dyspnea is one of it’s very rare side effects. We hereby report one such uncommon case of topiramate induced dyspnea CASE PRESENTATION: A 26-year-old female with a past medical history of migraines, on topiramate for nearly 1 year, presented to our emergency room with worsening dyspnea on exertion for 1 week. She was found to have an elevated D-dimer level (600ng/dl). Vital signs at the time of presentation were stable. There was no evidence of hypoxemia. She was admitted for further evaluation and underwent an extensive cardiopulmonary work up including a ventilation perfusion scan, computed tomography angiogram of the chest, lower extremity Doppler's, electrocardiogram, echocardiogram, chest x-ray, brain natriuretic peptide level, and thyroid function testing which were all within normal limits and failed to show any cause of her symptoms (Table 2). During her hospital course her shortness of breath (SOB) was easily reproducible with minimal ambulation without desaturation. She was discharged from the hospital and advised to follow with cardiology and pulmonary physicians. Her outpatient work up included pulmonary function testing and treadmill stress testing, which were again unrevealing. After further review of her case, her topiramate was discontinued as this was thought to be the possible cause of her dyspnea. Her SOB returned to normal within 3 days of discontinuation, establishing the diagnosis of topiramate induced dyspnea. DISCUSSION: Topiramate is an approved neuromodulator for migraine prophylaxis since 1996. It has 4 known mechanisms of action which include being a sodium channel blocker, potentiating gamma amino butyric acid, a glutamate antagonist, and inhibiting isoenzymes of carbonic anhydrase [2]. The first 3 mechanisms are responsible for its neurologic effect while the fourth induces a type 2 renal tubular acidosis leading to metabolic acidosis. While metabolic acidosis is a common side effect (35%) of topiramate, it rarely produces dyspnea (1-3%). There are only a few reported cases of topiramate induced dyspnea, first in 2007 [3]. All of the reported cases had no definitive cause for SOB identified after extensive work up, however all of those patients had improvement in their respiratory status once topiramate was discontinued within 72 hours as in our case CONCLUSIONS: Dyspnea is a rare adverse effect of topiramate which should be considered while evaluating a patient with dyspnea of unexplained origin after full cardiac and pulmonary workup are complete Reference #1: Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41:646 Reference #2: Montenegro M.A., Guerreiro M.M., Scotoni A.E., and Guerreiro C.A.: Predisposition to metabolic acidosis induced by topiramate. Arq Neuro-Psiquiatr 2000; 58: pp. 282-284 Reference #3: Delpirou-Nouh C, Gelisse P, Chanez P, Carlander B.: Migraine and topiramate induced dyspnea. Headache. 2007 Nov-Dec;47(10):1453-5. Epub 2007 Sep 12. DISCLOSURES: No relevant relationships by John Mikhail, source=Web Response No relevant relationships by Mohammed Shariff, source=Web Response" @default.
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• W2980706997 title "TOPIRAMATE-INDUCED DYSPNEA: A RARE ADVERSE EFFECT" @default.
• W2980706997 doi "https://doi.org/10.1016/j.chest.2019.08.1190" @default.
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