Topiramate in pseudotumor cerebri

 Q: Why Topiramate, an antiseizure drug is considered one of the drugs of choice for the treatment of Idiopathic intracranial hypertension (pseudotumor cerebri). What makes it eligible? 

 Answer: It is true that Acetazolamide still holds a place as the first line of drug for the treatment of idiopathic intracranial hypertension (IIH), popularly known as pseudotumor cerebri. Acetazolamide is a carbonic anhydrase inhibitor and reduces cerebrospinal fluid (CSF) production. 

Topiramate is an antiseizure medication but also carries the property of inhibiting that carbonic anhydrase activity. Allegedly, the same mechanism plays a role in its efficacy for the treatment of migraines. It is found to have equivalent efficacy in the treatment of IIH as acetazolamide. It also improves symptoms of IIH including visual field loss.  It is also known to cause weight loss, another target desired in the treatment of IIH.

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References:

1. Celebisoy N, Gökçay F, Sirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 2007; 116:322. 

2. Shah VA, Fung S, Shahbaz R, et al. Idiopathic intracranial hypertension. Ophthalmology 2007; 114:617. 

3. Friedman DI, Eller PF. Topiramate for the treatment of idiopathic intracranial hypertension. Headache 2003; 43:592.