Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2021) 78 OC6.3 | DOI: 10.1530/endoabs.78.OC6.3

BSPED2021 Oral Communications Oral Communications 6 (5 abstracts)

Topiramate as a treatment option in managing obesity complicated by idiopathic intracranial hypertension and chronic migraine in children and adolescents

Rhianwen Mathews 1 , Amber Syed 1 , Sam Amin 2 , J.P.H Shield 1,3 & Dinesh Giri 1,4

1Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, United Kingdom; 2Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, United Kingdom; 3National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, United Kingdom; 4Department of Translational Health Sciences, University of Bristol, Bristol, United Kingdom

Background: Childhood obesity is associated with multitude of co-morbidities. Idiopathic intracranial hypertension (IIH) is one of the less common co-morbidities in children and young people. Severe migraine has been postulated as a further association. We report our experience of using topiramate for managing obesity associated IIH and severe persistent migraine.

Cases: Case One: A 12 year old boy was referred with morbid obesity, systemic hypertension and IIH. Acetazolamide was used to treat IIH initially but was stopped due to sustained reduction in plasma bicarbonate. Topiramate was commenced, subsequently his weight reduced 4 kg over two months, with a BMI (SDS) improvement from 39.25 (+3.6SDS) to 36.17 (+3.3SDS), a reduction of -0.3 SDS.

Case Two: A 10 year old girl was diagnosed with morbid obesity and associated IIH. Due to progressive weight gain her acetazolamide was switched to topiramate with the aim of achieving weight loss in addition to IIH symptom management. Her weight reduced by of 5.7 kg over ten months, BMI SDS reduced from +1.79 SDS to +0.9 SDS (-0.89 SDS reduction). Her topiramate was stopped two months later as she had attained a normal weight and headaches resolved.

Case Three: A 16 year old girl with persistent migraines was gaining weight despite lifestyle and dietary modifications (IIH had been excluded). She had gained 31.7 kg over two years, her BMI increasing from 37.3 to 44.6 (+3.9 SDS). Sumatriptan and propranolol had provided no benefit to migraines. Topiramate was commenced and her weight reduced by 10.3 kg over five months, her BMI(SDS) reduced from 44.6 (+3.9SDS) to 42.5 (+3.7SDS), a reduction of -0.2 SDS. The median BMI SDS reduction was -0.3 SDS in the above patients along with sustained improvement of their clinical symptoms in a short time span. None of the patients experienced significant side effects from topiramate.

Discussion: Topiramate is known to suppress appetite but whether mainly through appetite suppression and consequent weight loss or by carbonic anhydrase inhibition is not fully determined. Topiramate could be considered as potential therapy in IIH or severe persistent migraine associated with obesity. Randomised trials on topiramate involving children and adolescents would be beneficial.

Volume 78

48th Meeting of the British Society for Paediatric Endocrinology and Diabetes

Online, Virtual
24 Nov 2021 - 26 Nov 2021

British Society for Paediatric Endocrinology and Diabetes 

Browse other volumes

Article tools

My recent searches

No recent searches.