Effectiveness and safety of perampanel in adults with mesial temporal epilepsy

Abstract

Mesial temporal lobe epilepsy (MTLE) is a common epilepsy syndrome often refractory to antiepileptic drug (AED) treatment. The purpose of this study was to evaluate the effectiveness and tolerability of perampanel (PER) as add-on treatment for patients of MTLE.We pooled retrospective data from adult patients with MTLE, from a tertiary center in Taiwan, who were prescribed PER between March 2016 and December 2016. The retention, responder, and seizure-free rate as well as the treatment emergent adverse events were assessed after 6 months of PER adjunctive treatment in this single-center postmarketing study.Review of medical records revealed that adequate data were available for 44 patients who were being administered PER (mean age: 42.0 ± 13.3 years, 24 females; baseline mean seizure frequency: 5.4 per 28 days). Twelve patients exhibited hippocampal sclerosis (HS). Open-label PER was added to ongoing medications. Twelve patients withdrew because of ineffectiveness (n = 6) or adverse effects (n = 6). The retention rate was 72.7% at 6 months. On final evaluation, with a mean PER dose of 5.7 mg/day for 6 months, a ≥50% reduction in seizure frequency was observed in 46.9% of the patients, and 5 patients became seizure-free. The effectiveness was similar for patients with or without HS. Twenty-three patients (52.3%) experienced adverse effects. The most common adverse effects were dizziness, ataxia, and irritability.Our results suggest that PER, at doses of 2 to 12 mg/day, reduces seizure frequency effectively with acceptable safety profiles for adults with MTLE.

Effects of Perampanel on Seizure Control, Cognition, Behavior, and Psychological Status in Patients With Epilepsy: A Systematic Review

“…Lin et al 26 reported a 46.9% responder rate at a 6-month follow-up in patients receiving PER therapy for MTLE and hippocampal sclerosis. Among the patients, 11.3% obtained complete seizure-free status during the study period, although half of the patients experienced mild-to-moderate AEs.…”

“… 30 32 For drug-resistant patients, studies have also demonstrated the effectiveness of PER in symptomatic epilepsy. 25 26 27 Responder and seizure-free rates have varied widely across studies, with PER being found to offer benefits in about 10%–30% of these patients.…”

“…More than 50% of patients experienced mild-to-moderate AEs with PER treatment, with dizziness and fatigue being the most common. 26 Nevertheless, effects on cognitive function, and psychiatric and behavior deterioration have raised concerns among PER recipients. Irritability, aggression, and suicidal ideation are the most-common reasons for discontinuing its use.…”

Efficacy and tolerability of perampanel in patients with seizures in real-world clinical practice: A systematic review and meta-analysis

“…A total of five studies provided data regarding seizure-free rates. The original seizure-free rates were lower in drug-resistant patients with epilepsy (Rinaldi and De Maria, 2018;Lin et al, 2019) than in those who had PER as their first add-on therapy (Santamarina et al, 2020). The pooled seizure-free rates were 17.0% (95% CI: 0.06-0.29) and 25.0% (95% CI: 0.08-0.42) for the PER plus EIAEDs and PER plus non-EIAEDs groups, respectively (Supplementary Figure S3).…”

“…Ikemoto et al, 2019;Kanemura et al, 2019;Lin et al, 2019;Maschio et al, 2019;Stavropoulos et al, 2019;Takahashi et al, 2019;Abril Jaramillo et al, 2020;Coppola et al, 2020;Kim et al, 2020;Liguori et al, 2020;Maschio et al, 2020;Moraes et al, 2020;Pascarella et al, 2020;Santamarina et al, 2020;Toledano Delgado et al, 2020;Yamamoto et al, 2020;Basheikh and Sadler, 2021;Canas et al, 2021;Davis Jones et al, 2021;Im et al, 2021;Inoue et al, 2021;Labate et al, 2021;Lattanzi et al, 2021;Limotai and Jirasakuldej, 2021; Lossius et al, 2021;Nilo et al, 2021;Rodríguez- Osorio et al, 2021;Sagar et al, 2021;Zhang et al, 2021;Chinvarun, 2022;Husni et al, 2022). A diagram summarizing the process of study selection is shown in Figure1.…”