Topiramate is biochemically classified as a fructopyranose sulphamate. Discovered as early as 1979, during middle 1980's it was approved in many countries for the treatment of epilepsies and migraine prevention. More recently, in the experimental stage, possible new indications have been disclosed: treatment of obesity, bipolar disorder, also cessation of smoking, neuropathic pain, cerebral pseudotumour, bulimia, periventricular leucomalatia in preterm infants and alcohol addiction. Most epileptologists consider it to be the first choice antiepileptic drug in severe pharmacoresistant epilepsies. A substantial corpus of evidence in paediatric population has been accumulated that confirms its efficiency in the treatment of generalised tonic-clonic seizures, Lenox-Gestaut syndrome, partial, absence and combined seizures. Having a unique monosaccharide chemical structure among other anticonvulsant drugs, characterizes it with special pharmacokinetic features. This substance exhibits a low interindividual variability in plasma levels and hence it features predictable pharmacokinetics. A steady state plasma concentration of topiramate increases linearly with higher dosages. Serum protein binding is approximately 15%, and biologic half-life in healthy volunteers is considered to range from 20 to 30 hours. Mean expected distribution volume rates from 0.55-0.8 l/kg, and accordingly, the drug shows a low and saturable binding capacity toward erythrocytes. It has not been present at the market for a sufficiently long time that would enable us to speak about a significant accumulation of data on its metabolism based on post-registration 4th stage clinical trials. For this purpose, we have done a literature review in order to summarise so far reported experience on topiramate pharmacokinetics in patients and healthy adults. Deeper understanding of its pharmacokinetic profile could enable a better technological design of the produced drug and the choice of the adequate route of its administration, and accordingly a more rational treatment of severe epilepsies resistant to other drugs.

INTRODUCTION Good knowledge of diabetic patients about their disease is often not related with good glycemic control. The aim of this study was to determine the level of application of acquired knowledge about diabetes in recognizing and resolving hypoglycemic and hyperglycemic conditions in patients who did or did not do blood glucose self-monitoring as well as the impact of self-monitoring on HbA1c during education of patients with diabetes type 2. MATERIAL AND METHODS There were 91 patients with the type 2 diabetes who completed six months education about their disease in four family medicine practices in Tuzla Canton during the period from March to September 2005. The patients who did or did not do self-monitoring with glucometer were interviewed on knowledge about recognizing and resolving hypoglycemia and hyperglycemia by family physician and HbA1c was assessed at the beginning of the education, 3 months after reading the brochure (passive education) and additional 3 months of group (intensive) education. RESULTS Out of 91 interviewed patients, there were 29 who did self-monitoring by glucometer at the beginning of the education, 30 patients during the passive education and 34 after the intensive education. At the beginning of education, regardless of doing self-monitoring, the patients were less able to recognize and resolve hypoglycemia and even less hyperglycemia. At the end of education, their knowledge was better at both recognizing and resolving hypoglycemia (P=0.01) as well as at recognizing (P=0.01) and resolving hyperglycemia (P=0.001). In the patients who did self-monitoring the average value of the HbA1c did not improve significantly (P=0.44) compared to those who did not practice self-monitoring (P=0.10) during education. CONCLUSION Only one third of patients with type 2 diabetes had done self monitoring with glucometer and although their knowledge about hypoglycemia and hyperglycemia was improved during education, these patients did not have improved significant values of the HbA1c compared to patients who had not done self-monitoring.