Treatment of nocturnal eating syndrome and sleep-related eating disorder with topiramate

Abstract

Background: Sleep-related eating disorder (SRED) and nocturnal eating syndrome (NES) combine features of sleep disorders and eating disorders. Treatment of these nocturnal eating behaviors has been directed towards underlying identifiable sleep or eating disorders using dopaminergic or opioid agonists, as well as anorectic agents, at times with the addition of sedatives.

Methods: Two patients with SRED and two with NES, who had failed multiple previous trials of pharmacotherapy and psychotherapy, were treated in a naturalistic, open-label fashion with topiramate at night. Reduction in nocturnal eating was graded based on self-report. Weight was computed at the outset of, and during, topiramate treatment.

Results: One patient with NES had a complete elimination of nocturnal eating with topiramate, two patients (one with NES, one with SRED) had a marked response, and one patient (with SRED) had a moderate response. Mean dose was 218 mg, though three patients noted an improvement at 100 mg. Notable weight loss was observed in all patients (mean of 11.1 kg). Benefits of topiramate treatment have been maintained for a mean period of 8.5 months.

Conclusions: Topiramate may be of benefit for patients with NES or SRED in reducing nocturnal eating, improving nocturnal sleep, and producing weight loss.

Introduction

Over the past 50 years, multiple case series of patients have been described who eat inappropriately during arousals from nocturnal sleep [1], [2], [3], [4], [5]. This behavior has been variably labeled as sleep-related eating disorder (SRED) or nocturnal eating syndrome (NES), depending upon the investigators and specific features of the behavior. Both syndromes are characterized by compulsive eating of high caloric foods at night, poor sleep quality, and morning anorexia. Both SRED and NES are most commonly present in females, usually beginning in young adulthood. SRED has generally been characterized as occurring during partial arousals from sleep, in which consciousness is only partially achieved, and is often associated with amnesia for the event. Primary sleep disorders, most prominently restless legs syndrome (RLS) and somnambulism, have been common in these individuals. On the other hand, NES occurs with maintenance of full awareness, though the binge eating is compulsive and difficult to suppress. Such individuals do not have amnesia, and sleep disorders have not been as prominent.

Treatment of these nocturnal eating behaviors has often been directed towards underlying identifiable sleep disorders (e.g. CPAP for obstructive sleep apnea [3], dopaminergic agonists/benzodiazepines for RLS [3], [6]), or psychiatric disorders (e.g. selective serotonergic reuptake inhibitors for bulimia nervosa). On the other hand, Schenck and Mahowald [7] have described success with combinations of dopaminergic and opioid drugs, at times with the addition of sedatives, even in patients without identified sleep disorders which are responsive to these medications. In two other reports of unblinded trials, the anorectic serotonergic agents fenfluramine [5] and dexfenfluramine [8] were used with good results.

We now describe effective treatment of four cases of nocturnal eating with the GABA agonist, glutamatergic antagonist, topiramate. This agent produced weight loss over periods of 6–12 months in large studies of patients with epilepsy (for which it has FDA indication) [9]. Topiramate was also beneficial in nine of 13 patients with daytime binge eating disorder, with marked reductions in daytime binge episodes [10]. Topiramate has also been associated with weight loss when it has been used as adjunctive treatment for bipolar disorder [11] and migraine [12].