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Objective: Our study assessed perampanel monotherapy in patients (aged ≥12 years) with focal-onset seizures (FOS) with or without focal to bilateral tonic-clonic seizures (FBTCS) in Japan and South Korea. Methods: Study 342 (NCT03201900; FREEDOM) is a single-arm, open-label, Phase III study. Patients initially received perampanel in a 32-week 4-mg/d Treatment Phase (6-week Titration; 26-week Maintenance Periods). If they experienced a seizure during the 4-mg/d Maintenance Period, they could be up-titrated to 8 mg/d across an additional 30-week Treatment Phase (4-week Titration; 26-week Maintenance Periods). Primary endpoint was the seizure-freedom rate during the Maintenance Period (4 mg/d and last evaluated dose [4 or 8 mg/d]). Secondary endpoints included time to first seizure onset and to withdrawal during Maintenance. Treatment-emergent adverse events (TEAEs) were monitored. Results: At data cutoff (February 28, 2019), 89 patients with FOS (84 [94.4%] with newly diagnosed epilepsy and 5 [5.6%] with recurrence of epilepsy after a period of remission) had received ≥1 perampanel dose; 16 patients discontinued during the 4-mg/d Titration Period, meaning 73 patients entered the 4-mg/d Maintenance Period and were included in the primary analysis set for efficacy. Seizure-freedom rate in the 26-week Maintenance Period was 46/73 (63.0%; 95% confidence interval [CI]: 50.9-74.0) at 4 mg/d and 54/73 (74.0%; 95% CI: 62.4-83.5) at 4 or 8 mg/d. | 275 YAMAMOTO eT Al.F I G U R E 1 Study design. a In the event of tolerability issues, the dose of perampanel could be reduced from 4 mg/d to 2 mg/d during Weeks 3 and 4 of the Titration Period, at the investigators' discretion. If the dose could not be up-titrated back to 4 mg/d, patients were discontinued from the study. b Patients experiencing seizures while receiving perampanel 4 mg/d could receive perampanel 8 mg/d at the investigators' discretion. If the 8-mg/d dose was not tolerated, patients could be down-titrated to 6 mg/d and continue the Maintenance Period. If patients experienced seizures while receiving perampanel 6 or 8 mg/d, or if the 6-mg/d dose was not tolerated, they ended the Treatment Phase. Abbreviation: QD, once daily

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Objective: Application of spatially filtered magnetoencephalography (MEG) to investigate changes in the mechanism of cerebral motor control in patients with tumours around the central sulcus. Methods: MEG records were made during a repetitive hand grasping task in six patients with gliomas around the central sulcus and in four control subjects. Power decreases in the a (8-13 Hz), b (13-30 Hz), and low c bands (30-50 Hz) during the motor tasks (event related desynchronisation, ERD) were analysed statistically with synthetic aperture magnetometry. The tomography of ERD was superimposed on the individual's magnetic resonance image. Results: b ERD was consistently localised to the contralateral primary sensorimotor cortex (MI/SI) in control subjects, whereas the a and low c ERD showed considerable intersubject variability. b ERD in patients during non-affected side hand movement was also localised to the contralateral MI/SI, but exclusively to the ipsilateral hemisphere during affected side hand movement. Conclusions: The altered pattern of ERD in the patient group during affected side hand movement suggests recruitment of diverse motor areas, especially the ipsilateral MI/SI, which may be required for the effective movement of the affected hand.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.

Movement-related magnetic fields were recorded with a whole-head magnetoencephalographic system in three dextrals and three sinistrals during right or left index finger extension. The motor field (MF) demonstrated an asymmetrical isofield map pattern with larger field reversal over the contralateral hemisphere for dominant hand movement and an almost symmetrical pattern for non-dominant hand movement in each subject. The equivalent current dipole moment of the MF for the contralateral hemisphere was significantly larger than the ipsilateral hemisphere for dominant hand movement, and almost equal for both hemispheres for non-dominant hand movement. These results were congruent for both dextrals and sinistrals, suggesting a more important role of the hemisphere contralateral to the dominant hand in unilateral voluntary movement, regardless of handedness.