Treatment with anticonvulsant topiramate (sold under the brand names Topamax, Trokendi XR, and Qudexy XR) may help reduce food-related aggression and cravings in Prader-Willi syndrome (PWS) patients, a case report suggests.
The research, “Topiramate in the treatment of Prader-Willi syndrome: A case report,” was published in the journal The Mental Health Clinician.
PWS patients may experience diverse symptoms that change slowly throughout their lives, and include poor muscle tone, underdeveloped genitals, cognitive impairment, mood disturbances, speech problems, and hyperphagia, or excessive hunger.
Hyperphagia is frequently the most concerning symptom due to the risk of obesity and other cardiometabolic complications. If addressed early, diet and weight control improves PWS prognosis. However, the long-term commitment needed may lead to poor adherence and be an obstacle to successful intervention.
There is not yet a U.S. Food and Drug Administration-approved medication for any of the symptoms of PWS.
In this case report, scientists presented the case of an 11-year-old boy who was admitted to a children’s crisis unit with a history of attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, obesity, and asthma, which is in line with a PWS diagnosis. The boy became violent and destructive if denied excessive amounts of food.
His medications included clonidine for ADHD, hydroxyzine for anxiety and insomnia, Singulair (montelukast) for asthma, and quetiapine, an antipsychotic, for mood stabilization.
According to his foster mother, the initial introduction of quetiapine worsened his compulsive eating and violent behaviors toward food. The boy’s biological father had schizophrenia, while the maternal side had a history of anxiety.
On the second and third days of his hospital stay, the boy was eating excessively and demanding food. Quetiapine was then discontinued, and topiramate at 25 mg twice daily, as well as the antiepileptic aripiprazole and the ADHD medication methylphenidate, both at 5 mg daily, were added to the treatment regimen.
The patient responded well, showing reduced aggression by the fourth day, but, on day six, he attacked staff, and continued to be aggressive toward food and resisted healthy choices offered to him. Topiramate was then increased to 50 mg twice daily and methylphenidate to 10 mg daily.
However, on the eighth day, he had to be placed in restraints for two hours due to violent and threatening behaviors not related to food. Aripiprazole was subsequently increased to 10 mg twice daily, and topiramate to 100 mg twice daily. The boy also began taking the anticonvulsant divalproex at 250 mg twice daily, and methylphenidate at 5 mg before lunch. He then showed progressive control of food-related impulses.
Between days 16 and 28, the boy exhibited further improvement of behavior control and less food-related aggression. He reported being “happy” with the medications and not eating as much due to a lessened appetite.
The patient was discharged on day 28, taking 100 mg of topiramate twice daily, 0.1 mg of clonidine three times daily, hydroxyzine at 25 mg in the morning and 50 mg at bedtime, 5 mg of Singulair at bedtime, methylphenidate at 10 mg in the morning and 5 mg in the afternoon, and 10 mg aripiprazole twice daily.
“This case demonstrates the positive effects of topiramate for reducing aggression and demand for food in a child with PWS most likely due to an increase in satiety,” the researchers wrote.
According to them, although no definitive conclusions can be drawn regarding direct effects of topiramate, since other therapies were also part of the treatment’s regimen, “it is possible that the significant improvement in this child’s aggressive behaviors toward food was reduced due to the known side effect of decrease in appetite with this medication.”
Based on the results, as well as on prior data showing decreased compulsive eating in PWS youths taking topiramate, the medication “seems to be a promising treatment option for young patients with PWS,” they conclude, adding that “since medication options in this disease are limited, further research should be conducted to determine if topiramate is effective.”