Analysis of the clinical experience with perampanel in the Moscow Region: Efficacy, tolerability, individual choice priorities

Abstract

Objective: to analyze our clinical experience with perampanel (PER), by evaluating the efficacy, tolerability, and individual choice priorities.Patients and methods. The investigation enrolled 28 patients with drug-resistant focal epilepsy; the patients' mean age was 38.3±10.7 years. The proportion of men was 46.4%; the disease duration was 8 to 33 years (mean 20.2 years). Antiepileptic drugs (AEDs) were changed 7–10 times in 66% of the patients and 5–6 times in 23%. The efficacy and tolerability of AEDs and the electroclinical features of epilepsy were compared in two groups: responders and non-responders.Results and discussion. The responder and non-responder groups had a substantial preponderance of patients with frontal lobe epilepsy and diffuse epileptiform electroencephalographic (EEG) patterns (80%:46% and 80%:38%, respectively; p = 0.0001), but those with temporal lobe epilepsy and isolated regional EEG patterns were 2–3 times fewer (20%: 53.8% and 20%:61.5%; p = 0.0001). Only one of 10 combinations of carbamazepine (CBM) and PER was successful. Aggression, fear, and psychosis, which occurred in 5 (17.8%) patients taking PER 2–6 mg/day, were the most common adverse reactions associated with its discontinuation. PER is an effective agent to overcome of drug resistance in epilepsy. The benefit of the drug is that it may be used in undifferentiated antiepileptic therapy regimens. When predicting the effects of PER, preliminary switch from CBZ to oxcarbazepine or eslicarbazepine is reasonable.

Keywords

• perampanel
• drug-resistant focal/partial epilepsy
• efficacy
• tolerability
• safety
• adverse events
• side effects