Clinical experience with perampanel: focus on psychiatric adverse effects

Epilepsy Behav. 2014 Dec;41:193-6. doi: 10.1016/j.yebeh.2014.09.072. Epub 2014 Oct 30.

Abstract

Background: Perampanel (PER) is a novel antiepileptic drug that inhibits the AMPA class of glutamate receptors. It has been available in the UK since September 2012. We undertook a retrospective analysis of efficacy and tolerability of PER in 47 patients with drug-refractory epilepsy attending a regional epilepsy service in the UK.

Methods: Demographic and clinical data of patients with refractory epilepsy prescribed PER were collected by review of records. Efficacy, as measured by responder rates (>50% reduction in seizure frequency), retention rates, and adverse effects, was analyzed.

Results: Of the 47 patients prescribed PER, 39 (87%) had focal epilepsy, four (9%) had idiopathic generalized epilepsy, 3 (6%) had symptomatic generalized epilepsy, and 1 had unclassified epilepsy. Patients were taking a median of 2 AEDs (range: 1-5) when starting on PER. The median dose of PER was 8 mg (range: 2-12 mg). Thirteen (28%) patients were classed as responders, but no patients experienced sustained seizure freedom. Twenty-one (45%) patients had withdrawn from PER during the study period, with 16 (76%) of them withdrawing due to intolerable adverse effects, 4 due to inadequate seizure control, and 1 due to the combination of both. The most frequent adverse effects requiring withdrawal from PER were behavioral reactions including suicidal ideation (n = 2), aggressive behavior (n = 2), and both (n = 1).

Conclusion: In our experience, PER had a retention rate of 55% and a responder rate of 28%. Psychiatric adverse effects, including suicidal ideation, were the most common reasons for withdrawal.

Keywords: Epilepsy; Perampanel; Suicidality.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / adverse effects*
  • Anticonvulsants / pharmacology
  • Drug-Related Side Effects and Adverse Reactions*
  • Epilepsy / drug therapy*
  • Female
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Pyridones / administration & dosage
  • Pyridones / adverse effects*
  • Pyridones / pharmacology
  • Retrospective Studies
  • Suicidal Ideation*
  • Treatment Outcome
  • Young Adult

Substances

  • Anticonvulsants
  • Pyridones
  • perampanel