Perampanel Add-On Therapy Effectively Treats Focal and Generalized Epilepsy

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Low-dose perampanel was an effective first add-on in the study.
Low-dose perampanel was an effective first add-on in the study.

The following article is part of conference coverage from the American Epilepsy Society's Annual Meeting in New Orleans, LA. The Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

NEW ORLEANS — Perampanel (PER) is an effective first add-on treatment in patients with nonrefractory epilepsy according to research presented at the 72nd Annual Meeting of the American Epilepsy Society, held November 30-December 4, 2018, in New Orleans, LA.

Researchers conducted a multicenter, observational, consecutive, and retrospective study in 22 Spanish hospitals. They included patients aged 12 years and older with a definite history of focal or idiopathic generalized epilepsy who were previously treated with 1 or 2 antiepileptic drugs on monotherapy and then treated with PER as a first add-on therapy. 

The study included 149 patients between the ages of 12 and 84 with a mean age of 41 years old. Overall, 81 participants were male (54.4%). The most common epilepsy type was focal epilepsy (113 patients; 77.9%), and the most common subtype was temporal lobe epilepsy (39 patients; 26.9%). The primary reason for initiating PER was poor seizure control (104 patients; 86.0%). 

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The mean dose of PER given was 6.2 mg/day (2-12 mg/day). The most common administration was 2 mg every 4 weeks (39.7%), then 2 mg every 2 weeks. Retention rates for PER treatment were 98% at 3 months, 88.6% at 6 months, and 85.2% at 12 months.

After 12 months, 126 patients (84.6%) saw at least a 50% reduction in seizure frequency including 98/118 (83.1%) with focal seizures and 26/31 (83.9%) with generalized seizures. A total of 68 participants (45.6%) achieved seizure freedom including 46/118 (39%) with partial seizures and 19/31 (61.3%) with generalized seizures.

Researchers noted at least 1 adverse event in 72 (48.3%) patients. These adverse events were mostly mild to moderate, with the most common adverse events being dizziness (15.4%), irritability (14.1%), and somnolence (14.1%). 

More than half of these adverse events subsided by months 6 to 12. Rates of efficacy and retention were much greater in patients who were not treated simultaneously with sodium channel blockers (54.5% seizure free vs 32.8%; =.009).

Results from this study indicate that PER, given at low doses, is an effective first add-on treatment for focal and generalized epilepsy. The treatment exhibited high rates of retention, reduction in seizure frequency, and seizure freedom with relatively mild and nonpersistent adverse events. 

For more coverage of AES 2018, click here.

Reference

Alegre VB, Irigoyen VG, Gomara MJG, et al. Effectiveness and tolerability of perampanel in adolescents and adults as a first add-on therapy: an observational multicentre study. Presented at: 2018 AES Annual Meeting; November 30–December 4; New Orleans, LA. Abstract 1.307. 

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