Treatment of paraphilic sexual disorder: the use of topiramate in fetishism.

Topiramate, a newer anticonvulsant, has a modulating effect on voltage-dependent sodium and calcium ion channels, potentiates GABA neurotransmitters and blocks kainite/AMPA glutamate receptors. We describe the use of topiramate in the treatment of fetishism, a paraphilic sexual disorder. A 23-year-old male had developed sexual fantasies and urges towards women's feet and shoes from childhood onwards. The patient would masturbate with women's shoes, which he had bought or stolen from others. He would feel sexually excited by seeing and/or smelling female feet and shoes. He had received individual psychotherapy because of his unusual sexual expressions, marked distress and interpersonal difficulty. However, the psychotherapy was not effective and his symptoms of fetishism did not abate until he had been treated with topiramate (200 mg per day). He has been on the dose of this medication for more than 6 months and his symptoms of fetishism have since diminished. In addition, he has not experienced any significant side-effect with this medication. Experience with our patient suggests that topiramate may be effective in treating paraphilic sexual disorders. Further controlled studies are required to confirm its efficacy in patients of this type.