Psychotic Symptoms Associated With Topiramate: Cognitive Side Effects or Worsening of Psychosis?

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Sir: Hofer et al.¹ report worsening of psychosis in a patient treated with topiramate. There are anecdotal reports in the literature suggesting this adverse effect of topiramate. However, the pathophysiologic mechanism cited by the authors to explain this worsening of psychosis is contrary to what the literature suggests.