It is not possible to draw any firm conclusions about the use of topiramate in clinical practice from this evidence .
BACKGROUND Bipolar disorder is a common recurrent illness with high levels of chronicity .
Previous trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder .
This is an up date of a previous Cochrane review ( last published 2006 ) on the role of topiramate in bipolar disorder .
OBJECTIVES To assess the effects of topiramate for acute mood episodes  in bipolar disorder in adults compared to placebo , alternative pharmacological treatment , and combination pharmacological treatment as measured by treatment of symptoms on specific rating scales for individual episodes .
A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects
BACKGROUND : Treatment of obese subjects with topiramate has recently been associated with significant weight loss in a 6-month dose-ranging study . OBJECTIVE : To investigate the long-term efficacy and safety of topiramate in obese subjects . DESIGN : R and omised , double-blind , placebo-controlled study investigating three doses of topiramate : 96 , 192 , and 256 mg/day . All subjects also participated in a nonpharmacological weight-loss programme . SUBJECTS : The study included 1289 subjects 18–75 y with a body mass index ≥30 kg/m2 and < 50 kg/m2 in the absence of comorbidities , or ≥27 kg/m2 and < 50 kg/m2 in the presence of controlled hypertension and /or dyslipidaemia . DURATION : The original study design was for a 6-week , single-blind , placebo run-in phase followed by an 8-week titration phase and 2 y of maintenance at the assigned dose . Sponsor ended study early in order to develop a new controlled-release formulation with the potential to enhance tolerability and simplify dosing in this patient population . Therefore , none of the subjects completed the full 2 y of treatment . Efficacy results are based on subjects who were enrolled early enough to have had an opportunity to complete 1 y at their assigned dose ( modified intent-to-treat population , MITT ) before learning of the decision to terminate the study . Safety results are based on all subjects who took at least one dose of study medication . RESULTS : The safety population consisted of 1282 subjects , and the MITT efficacy population was 854 subjects . At 60 weeks , subjects in the placebo group lost 1.7 % of their baseline body weight , while subjects in the topiramate 96 , 192 , and 256 mg/day treatment groups lost 7.0 , 9.1 , and 9.7 % , respectively ( P<0.001 , MITT , last observation carried forward ) . Weight loss ≥5 % of baseline weight was achieved by 18 % of subjects in the placebo arm vs 54 , 61 , and 67 % of subjects receiving topiramate 96 , 192 , and 256 mg/day , respectively ; weight loss ≥10 % was achieved by 6 vs 29 , 40 , and 44 % , respectively ( P<0.001 ) . Weight loss was accompanied by significant improvements in blood pressure ( systolic/diastolic changes of + 0.4/+1.0 , −3.1/−1.3 , −5.7/−3.4 , and −4.6/−2.4 mmHg were observed for placebo , topiramate 96 mg/day , 192 mg/day , and 256 mg/day , respectively , P<0.001 ) and glucose and insulin . The most common adverse events more frequently observed in topiramate-treated subjects occurred mostly during the titration phase and were related to the central or peripheral nervous system and included paresthesia , difficulty with concentration/attention , depression , difficulty with memory , language problems , nervousness , and psychomotor slowing . CONCLUSION : Topiramate treatment of obese subjects over the course of 1 y result ed in clinical ly significant weight loss . Improvements were also observed in blood pressure and glucose tolerance
It is not possible to draw any firm conclusions about the use of topiramate in clinical practice from this evidence .
BACKGROUND Bipolar disorder is a common recurrent illness with high levels of chronicity .
Previous trials have suggested that the anticonvulsant topiramate may be efficacious in bipolar disorder .
This is an up date of a previous Cochrane review ( last published 2006 ) on the role of topiramate in bipolar disorder .
OBJECTIVES To assess the effects of topiramate for acute mood episodes  in bipolar disorder in adults compared to placebo , alternative pharmacological treatment , and combination pharmacological treatment as measured by treatment of symptoms on specific rating scales for individual episodes .