Effectiveness of perampanel as a first add-on antiepileptic drug for the treatment of partial epilepsy

Satoru Takahashi; Kazuhide Shimizu; Motoki Inaji; Satoka Hashimoto; Shinji Yamamoto; Taketoshi Maehara

doi:10.1016/j.yebeh.2019.106492

Effectiveness of perampanel as a first add-on antiepileptic drug for the treatment of partial epilepsy

Epilepsy Behav. 2019 Nov;100(Pt A):106492. doi: 10.1016/j.yebeh.2019.106492. Epub 2019 Oct 21.

Authors

Satoru Takahashi¹, Kazuhide Shimizu², Motoki Inaji², Satoka Hashimoto², Shinji Yamamoto³, Taketoshi Maehara⁴

Affiliations

¹ Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. Electronic address: fluteplayanc@gmail.com.
² Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
³ Department of Neurosurgery, Tsuchiura Kyodo Generals Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Japan.
⁴ Department of Neurosurgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Neurosurgery, Tsuchiura Kyodo Generals Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028, Japan.

PMID: 31648158
DOI: 10.1016/j.yebeh.2019.106492

Abstract

Background: Perampanel (PER) is a newly introduced antiepileptic drug (AED) and is used in over 50 countries. In the current study, we analyzed the efficacy of PER for patients with partial epilepsy who were recruited from two hospitals that had both an epilepsy center and a general neurosurgical unit over a 1-year period.

Methods: The present study was a retrospective observational study that evaluated the effects of PER for the treatment of partial epilepsy in 51 patients. We analyzed the effects of PER at two checkpoints, i.e., 6 and 12 months after starting adjunctive PER treatment. Following this, we analyzed the effects of PER as a first add-on (only one prior AED) and late add-on (≥2 prior AEDs) therapy, and focused on the characteristics of the patients who achieved seizure freedom.

Results: Of the initial 51 patients, 45 and 39 patients were evaluated at the 6- and 12-month checkpoints, respectively. Overall, after starting treatment with PER, 29% (13/45) and 28% (11/39) of patients were seizure-free at 6 and 12 months, respectively. The tolerance rate of PER was 67% (30/45) at 6 months and 53.8% (21/39) at 12 months following treatment. The seizure-free rate of the 30 patients who were continuously treated with PER for 6 months was significantly higher in the patients who used PER as a first add-on treatment (75.0%, 6/8) than it was in the patients who used PER as a late add-on treatment (31.8%, 7/22) (p = 0.049). The seizure-free rate of the 21 patients who were continuously treated with PER for 12 months was significantly higher in the patients who used PER as a first add-on treatment (100%, 5/5) than it was in the patients who used PER as a late add-on treatment (37.5%, 6/16) (p = 0.035). Among the patients who achieved seizure freedom, the most frequently administered dose of PER was 2 mg at 6 (62%, 8/13) and 12 months (64%, 7/11). Levetiracetam was the most frequently administered concomitant AED at both 6 (92%, 12/13) and 12 months (91%, 10/11).

Conclusion: This retrospective observational study provides evidence supporting the effectiveness of PER as a first add-on therapy in patients with partial epilepsy. Importantly, the seizure-free rate was better when PER was used as a first, rather than a second or later, add-on treatment.

Keywords: Antiepileptic drug; First add-on; Partial epilepsy; Perampanel.

Publication types

Observational Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anticonvulsants / therapeutic use*
Child
Drug Administration Schedule
Drug Therapy, Combination
Epilepsies, Partial / drug therapy*
Female
Humans
Longitudinal Studies
Male
Middle Aged
Nitriles
Pyridones / therapeutic use*
Retrospective Studies
Treatment Outcome
Young Adult

Substances

Anticonvulsants
Nitriles
Pyridones
perampanel