I have been recommended Topiramate (aka Topamax) and Divalproex, which is a form of valporate, (aka Epival) by two different Doctors. Is one better than the other?

I have been recommended Topiramate (aka Topamax) and Divalproex which is a form of Valporate (aka Epival) is one better than the other? I believe the Divalproex is a form of Sodium Valporate.

They are both commonly used to treat MAV.

As I mentioned in previous posts I highly suspect I have some sort of inner ear condition, but only one of my doctors was willing to make that assertion.

Hi there. As you say both are commonly used to treat MAV so it may not matter which one you start with, i.e. you can always switch if the result isn’t good or if the side effects of one are too much. If weight is a factor then topiramate does often cause weight loss whereas sodium valproate is known to do the opposite. But each person is different. I have tried topiramate (and I find even a low dose does help) but I have never tried sodium valproate.

How come you have been given two opinions? Have you seen two neurologists or is one from an ENT consultant? Of course your other option is to go with the opinion of the doctor you trust the most, or the one you think would be most willing to switch you if you asked!

Thanks for your response. A neurologist recommended the Epival.

I went to another jurisdiction to have a second opinion and rule our SSCD and Perilymph Fistula. He ruled those out (though they are hard to diagnose so you never know). He advised me to try Topamax.

In any case the treatment is largely the same. From my reading the surgery for PLF is not reliable and my take on this is that once you are past the emergency phase the ear is probably Hydropic which would be hard to patch because of the pressure. You may just have to let nature take its course and see it heal over time …


I see. Have you decided which one (if either) you are going to try? I expect by now you have been researching both. I know I would have been :slight_smile:

I just started my first dose of divalproex (250mg in morning). So far it has made me a bit worse, but it is just day one. I will increase my dose to 500mg if I can tolerate the symptoms.

I will update if I notice an improvement.

How’s it going?

I took it for 2 days and felt worse each day. I decided it wasn’t for me