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Clinical Cases and Reviews in Epilepsy

First clinical experiences with perampanel in adult patients with drug-resistant epilepsy and cognitive impairment

Brief report/Clinical case, 43 - 48
doi: 10.11138/ccre/2017.2.1.043
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Abstract
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The aim of the present study was to evaluate the efficacy and safety of perampanel (PER) in adult patients with drug-resistant epilepsy and cognitive impairment in clinical setting. We retrospectively analyzed treatment response, seizure outcome and adverse effects of PER in thirty-three adult patients (mean age 31.6 years, range 19-55) with drug-resistant epilepsy and cognitive impairment.
PER was started with 2 mg/day at bedtime and was up-titrated by 2 mg/day every 2-4 weeks.
Evaluation was carried out after 6, 9, 12 and 18 months of PER treatment. Patients were affected by focal epilepsy (of structural, metabolic or unknown etiology) (n=19), Lennox-Gastaut syndrome (n=8), Lafora disease (n=4), generalized genetic epilepsy (n=1), Dravet syndrome (n=1).
Retention rate was 93.9% at 3 months, 81.8% at 6 months, 66.7% at 12 months. The mean PER dosage was 6.4 mg (range 2-12) at the end of follow-up. An overall improvement of seizure frequency was obtained in 48.5% of patients after 12 months, with 9 patients (21%) experiencing a greater than 50% seizure reduction. Adverse events were experienced by 51.5% patients, leading to PER discontinuation in 42% of subjects. The most common adverse events were behavioral changes (primarily aggressiveness, 24%) and
dizziness (9%). Behavioral changes were not influenced by concomitant use of other drugs, but was observed in 7 out of 11 patients with a history of behavioral problems. PER may achieve clinically improvement for a small minority of patients with adult drug-resistant heterogeneous epilepsies and intellectual disability, although few patients achieved complete seizure control. Monitoring for psychiatric adverse effects is recommended. Further studies in larger cohort with a long-term follow-up are warranting.

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  1. First clinical experiences with perampanel in adult patients with drug-resistant epilepsy and cognitive impairment
    Orlando B., Martino T., Quitadamo S.G., Di Claudio M.T., Lalla A., Avolio C., d'Orsi G.
    doi: 10.11138/ccre/2017.2.1.043
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