Q:  Topamax & Seizures After Alcohol

My daughter recently had two seizures on the day following a night of drinking alcohol, and I am wondering if the fact that she has been on Topamax for the past two-and-a-half years has any influence on these two withdrawal seizures (both occurred 10-12 hours after drinking).  I have read that both alcohol and topiramate act on the GABAA receptor and both through the chloride ion influx mechanism.  Could adding alcohol to the chronic inhibitory action of topiramate lead to hyperexcitation as the alcohol wears off? In other words, I am wondering if topamax, instead of protecting her from having a seizure after alcohol, might actually exacerbate a withdrawal seizure. 

She has not had a seizure in four years, so I am curious about the etiology of these recent seizures and what they might reveal about her seizure disorder in general.  I am aware that alcohol lowers one’s seizure threshold, and I don’t think she will ever take the risk of drinking alcohol again.  However, if topiramate does contribute to withdrawal seizures after alcohol, I would like to know, since it might influence her neurologist’s treatment plan – and it might explain something – anything - about precipitating factors in her seizures.

Thank you
 

Dear Ms. H' -- 
Fair question. I don't know the answer.  Seems plausible to me, e.g. if there were some peak/trough effects with twice daily topiramate dosing and those coincided somehow with the alcohol "trough"; otherwise, as you point out, you'd think there would be some protective effect.  I wonder if some neurology website has an ask-a-doc you could query?

Dr. Phelps