Efficacy and safety of topiramate for reducing impulsivity: A transdiagnostic systematic review and meta‐analysis of a common clinical use
Fundam Clin Pharmacol. 2021-07-01; :
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Chapron SA(1), Nourredine M(1), Dondé C(2)(3)(4), Haesebaert F(5)(6), Micoulaud-Franchi JA(7)(8), Geoffroy PA(9)(10), Rolland B(1)(11)(12).
(1)Academic Department of Addiction Medicine of Lyon (SUAL), Le Vinatier
Hospital, Bron, France.
(2)Department of Medicine, University Grenoble Alpes, Grenoble, France.
(3)Psychiatry Department, University Hospital Grenoble Alpes, Grenoble, France.
(4)INSERM U1216, Brain Behavior and Neuromodulation Team, Grenoble Institute
Neuroscience, La Tronche, France.
(5)Faculty of Medicine Lyon-Est, University Claude Bernard Lyon 1, Lyon, France.
(6)Department SUR-CL3R-PEPS, Le Vinatier Hospital, Bron, France.
(7)USR CNRS 3413 SANPSY, Pellegrin University Hospital, University of Bordeaux,
(8)University Sleep Clinic, Services of functional exploration of the nervous
system, University Hospital of Bordeaux, Bordeaux, France.
(9)Department of Psychiatry and Addictive Medicine, University Hospital
Bichat-Claude Bernard, Public Hospitals of Paris, Paris, France.
(10)INSERM U1141, NeuroDiderot, Paris University, Paris, France.
(11)Academic Department of Addiction Medicine of Lyon (SUAL), Edouard Herriot
Hospital, Hospices Civils de Lyon, Lyon, France.
(12)INSERM U1028, CNRS UMR5292, PSY2R Team, Lyon Neuroscience Research Center,
University Claude Bernard Lyon 1, Lyon, France.
Impulsivity is an important transdiagnostic feature of many psychiatric
disorders, as well as a marker of poorer outcome. Topiramate is broadly used for
reducing impulsivity in various neuropsychiatric disorders, but no systematic
review or meta-analysis has ever explored whether evidence supports this clinical
use. We conducted a systematic review and meta-analysis of the literature, using
PubMed, PsycInfo and Cochrane databases. We included all studies assessing the
efficacy of topiramate in adults with high levels of impulsivity, based on either
psychometric or neuropsychological measures. Seven articles were included,
involving 578 participants. Important heterogeneity in designs and quality
features was observed. Topiramate lowered impulsivity levels in two of the
studies that used the Barratt Impulsiveness Scale (BIS) (401 participants) and in
one of the studies that used neuropsychological measures (63 participants). Four
other studies found no effect of topiramate on impulsivity. A larger reduction in
the BIS-11 overall score, with a mean difference of 2.57 (95% confidence interval
-4.12 to -1.02), was found in the topiramate group than the placebo group using a
random effects model. However, one study accounted for the major part (85.5%) of
it, and most included studies presented a high risk of bias. The use of a
self-assessment scale induced an additional risk of self-report bias. No
clear-cut evidence was found for a transdiagnostic effectiveness of topiramate in
reducing impulsivity levels. However, encouraging results were found in some
© 2021 Société Française de Pharmacologie et de Thérapeutique.