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It is believed to work through several pathways: Blocking voltage-dependent sodium channels , reducing neuronal excitability Enhancing GABA (gamma-aminobutyric acid) activity , an inhibitory neurotransmitter Antagonising glutamate receptors , further dampening excitatory neurotransmission Inhibiting carbonic anhydrase enzymes , though the clinical significance of this effect varies Topiramate is taken orally, typically once or twice daily

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Although water-referenced neurochemical concentrations are considered by some as the gold standard approach for MRS, there are numerous technical challenges and assumptions that can limit the utility of water-referenced measurements

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doi: 10.1016/j.jacc.2020.05.037 38 DaviesMJDAlessioDAFradkinJKernanWNMathieuCMingroneGet al