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Q: Nicotine and epileptic mood or attention deficits ( Answered 5 out of 5 stars,   2 Comments )
Subject: Nicotine and epileptic mood or attention deficits
Category: Health > Conditions and Diseases
Asked by: josephus-ga
List Price: $50.00
Posted: 25 Mar 2003 07:42 PST
Expires: 24 Apr 2003 08:42 PDT
Question ID: 180703
Can a nicotine patch enhance mood or improve attention for an epileptic on topomax?
Subject: Re: Nicotine and epileptic mood or attention deficits
Answered By: kevinmd-ga on 25 Mar 2003 10:48 PST
Rated:5 out of 5 stars
Hello - thanks for asking your question.

To research your question, I performed a Medline search.  There have
been several studies investigating the effects of nicotine on mood and

First of all, checking a drug database (using Epocrates Multicheck),
there was no interaction between topomax and nicotine.  Please discuss
with your personal physician any changes in medication regimen.

Davranche (2002) studied the effect of a low dose of transdermal
nicotine on cognitive processes.  They found that nicotine improves
the subjective state of alertness:
"The objective of this research was to assess the effect of a low dose
of nicotine (7 mg/24 h), administered through a transdermal device, on
the cognitive processes of subjects who were slightly dependent
smokers. Under suboptimal alertness conditions the subjects were faced
with a choice reaction time (CRT) task. The results obtained suggest
that nicotine improves the subjective state of alertness of the
subjects and enables them, despite the suboptimal state, to maintain a
constant performance level during a CRT task."

A study by Shytle (2002) tested the effect of transdermal nicotine in
attention.  The setting was ADHD - it found that the attention
symptoms of ADHD were reduced, however there were significant side
effects including nausea, itching, and stomach ache.
"OBJECTIVE: To test the hypothesis that transdermal nicotine would be
efficacious for the treatment of children and adolescents with
attention deficit hyperactivity disorder (ADHD) . . . As assessed by
the 48-item Conners Parent Rating Scale at endpoint and during the
trial, there was a significantly greater reduction in ADHD symptoms .
. . Nausea, stomach ache, itching under patch and dizziness were the
most frequently reported adverse effects associated with transdermal
nicotine. CONCLUSIONS: While the results of this study support
previous research indicating that nicotinic receptor modulation may be
a potentially useful strategy for the treatment of ADHD, therapeutic
uses of nicotine are limited due to side effects."

Griesar (2002) used a nicotine patch in non-smokers and found that it
increased alertness, but had no effect on attention:
"Nicotine reportedly improves covert orienting of spatial attention,
but enhanced alertness may also play a role. The present study
explored nicotine effects on measures of spatial attention and
alertness in non-smokers. Nicotine was delivered to 17 non-smokers
(data from 12 subjects were analyzed) by a 7-mg transdermal patch (one
patch in a low-nicotine condition; two patches in a high-nicotine
condition). We examined nicotine's effects on spatial attention using
a covert orienting task with central, predictive cue stimuli. Nicotine
effects on alertness were examined with EEG and subjective
questionnaires. Blood was drawn and serum levels of nicotine are
reported. Nicotine decreased overall reaction times in the covert
orienting task. There was no change in the validity effect, the
reaction time difference between validly and invalidly cued targets.
However, nicotine significantly improved both EEG and self-rated
measures of alertness. We conclude that nicotine increases alertness
in non-smokers, but we found no improvement in spatial attention using
a covert orienting task."

Min et al. (2001) used a nicotine patch can improve cognitive and
memory functions in non-smokers:
"RATIONALE: Nicotine has been found to improve cognitive functions in
patients with Alzheimer's disease, but little is known about its
effects in the healthy non-smoking elderly . . . RESULTS: The
subjects' memory functions in trial 5 of the Rey-Kim Memory Tests
improved significantly. Furthermore, the effect on memory slope was
significantly correlated with the higher plasma level of nicotine.
However, the other tests did not reveal any correlation to a
significant degree. CONCLUSIONS: These results suggest that nicotine
of lower plasma level can improve short-term verbal memory functions
in non-smoking or nicotine-naive healthy elderly people and that some
effects are dependent on nicotine plasma levels.

Levin et al. (2001) suggested that acute nicotine treatment can
improve attention in the setting of ADHD:
"Acute nicotine treatment has been found to reduce symptoms of
attention deficit/hyperactivity disorder in adults (E. D. Levin, C. K.
Conners, et al., 1996). In this study, chronic nicotine effects were
compared with placebo and methylphenidate. Acute and chronic nicotine
treatment significantly attenuated the rise in hit reaction time
standard error over session blocks on the Conners Continuous
Performance Test (C. K. Conners et al., 1996). Acute nicotine
significantly reduced severity of clinical symptoms on the Clinical
Global Impressions scale (National Institute of Mental Health, 1985).
Nicotine caused a significant decrease in self-report of depressive
mood as measured by the Profile of Mood States test (D. M. McNair, M.
Lorr, & L. F. Droppleman, 1981). This small study (40 participants)
provided evidence that nicotine treatment can reduce severity of
attentional deficit symptoms and produce improvement on an objective
computerized attention task."

Rusted et al. (2000) overviewed studies where they found that smokers
had small but significant benefits in attention and other cognitive
"The most robust demonstrations of the nicotine-related performance
effects on human cognitive processes are seen in tasks that measure
attention . . . In the laboratory measures of sustained attention and
in the everyday analogue, performance advantages were registered in
the smoking condition. These benefits were observed in smokers who
abstained for a self-determined period of not less than 2 h . . .
Small but significant improvements in performance were registered in
the everyday analogues, which involved sustaining attention in a dual
task situation, a telephone directory search task and a map search

Mancuso et al. (1999) studed the effects of nicotine on information
processing.  It was suggested that nicotine had benefit on the
intensity of attention:
"RATIONALE: It is now well established from electrophysiological and
behavioural evidence that nicotine has effects on information
processing. The results are usually explained either by a primary
effect of nicotine or by a reversal effect of a nicotine-induced,
abstinence deficit. In addition, there is dispute about the cognitive
processes underlying the changes in performance. . . . RESULTS:
Nicotine enhanced the speed of number generation and the speed of
processing in both the control and interference conditions of the
Stroop test. There were no effects on attentional switching of the
Flexibility of Attention test. CONCLUSION: The results are consistent
with the hypothesis that nicotine mainly improves the intensity
feature of attention, rather than the selectivity feature.

As you can see, there are studies suggesting an effect of nicotine on
attention and cognitive function.  Any medication change or
modification needs to be discussed thoroughly with your personal
physician.  Side effects may include arrhythmia, an allergic reaction
to the patch, headache, anxiety, dizziness, or nausea.

This answer is not intended as and does not substitute for medical 
advice - the information presented is for patient education only. 
Please see your personal physician for further evaluation of your 
individual case. 
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.       
Kevin, M.D.       
Search strategy:      
Medline using the following search terms:
nicotine and attention
nicotine and mood
nicotine and non-smoker
josephus-ga rated this answer:5 out of 5 stars
Researcher did a thorough and well-considered literature review to answer my query.

Subject: Re: Nicotine and epileptic mood or attention deficits
From: kevinmd-ga on 25 Mar 2003 12:35 PST
It has been brought to my attention that topamax (topiramate) may have
an effect in neutralizing the effects of nicotine.  Although there was
no formal drug interaction, consider this information:
"However, nicotine-related increases of norepinephrine and dopamine
were completely blocked in those rats treated with topiramate, and
dopamine elevation in the preaddicted rats was significantly modified.
However, topiramate did not drastically influence the effect of
nicotine on serotonin." 

It is possible that the cognitive and attention-improving effects are
serotonin based and not affected by topamax - there are not enough
studies in this area.

Kevin, M.D.
Subject: Re: Nicotine and epileptic mood or attention deficits
From: kevinmd-ga on 27 Mar 2003 10:52 PST
Thank you for the generous rating.

Kevin, M.D.

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