Perampanel as add-on treatment in refractory focal epilepsy. The Dianalund experience

TY - JOUR

T1 - Perampanel as add-on treatment in refractory focal epilepsy. The Dianalund experience

AU - Juhl, Caroline S

AU - Rubboli, G.

PY - 2016

Y1 - 2016

N2 - Background: Perampanel (PER) is an antagonist of AMPA receptors that has been approved for adjunctive treatment of partial-onset seizures. Aims: To evaluate effectiveness and safety of PER as add-on treatment in patients with severely refractory focal epilepsy. Methods: PER was introduced as add-on treatment in 22 consecutive patients with drug-resistant focal epilepsy. PER was started with 2 mg/day at bedtime and was up-titrated by 2 mg/day every 2–4 weeks. Results: All patients suffered from severely refractory focal epilepsy (86% took 2 or more AEDs prior PER initiation; 40% had been submitted to surgery or were surgery candidates; 7 had VNS). After 12 months since PER initiation, the retention rate was 54.5% and the responder rate was 27.2%, including 9.1% seizure-free patients. Mean PER dose in the responders was 8 mg/day (range 4–10). Most common side effects were tiredness, behavioral changes (primarily aggressivity), dizziness and were reported in 59.1% of patients, leading to PER discontinuation in 31.8% of subjects. Conclusions: PER as add-on treatment can achieve clinically meaningful improvement in patients suffering from severely refractory focal epilepses. Further studies are warranted to explore the tolerability profile, with particular focus on psychiatric adverse events.

AB - Background: Perampanel (PER) is an antagonist of AMPA receptors that has been approved for adjunctive treatment of partial-onset seizures. Aims: To evaluate effectiveness and safety of PER as add-on treatment in patients with severely refractory focal epilepsy. Methods: PER was introduced as add-on treatment in 22 consecutive patients with drug-resistant focal epilepsy. PER was started with 2 mg/day at bedtime and was up-titrated by 2 mg/day every 2–4 weeks. Results: All patients suffered from severely refractory focal epilepsy (86% took 2 or more AEDs prior PER initiation; 40% had been submitted to surgery or were surgery candidates; 7 had VNS). After 12 months since PER initiation, the retention rate was 54.5% and the responder rate was 27.2%, including 9.1% seizure-free patients. Mean PER dose in the responders was 8 mg/day (range 4–10). Most common side effects were tiredness, behavioral changes (primarily aggressivity), dizziness and were reported in 59.1% of patients, leading to PER discontinuation in 31.8% of subjects. Conclusions: PER as add-on treatment can achieve clinically meaningful improvement in patients suffering from severely refractory focal epilepses. Further studies are warranted to explore the tolerability profile, with particular focus on psychiatric adverse events.

KW - drug-refractory focal epilepsy

KW - efficacy

KW - perampanel

KW - psychiatric adverse events

KW - safety

KW - tolerability

U2 - 10.1111/ane.12558

DO - 10.1111/ane.12558

M3 - Comment/debate

C2 - 26763771

AN - SCOPUS:84991109072

SN - 0001-6314

VL - 134

SP - 374

EP - 377

JO - Acta Neurologica Scandinavica

JF - Acta Neurologica Scandinavica

IS - 5

ER -