Abstracts

Rationale: We evaluated the role of perampanel in people who continued to experience seizures after surgical intervention to better determine the effectiveness of this novel anti-epileptic drug (AED) in highly refractory epilepsy Methods: The study was approved by, and registered at, Oxford University Hospitals. Retrospective patient data were collected over a 12-month period from 5 centres throughout the United Kingdom. Principal inclusion criteria were: patients aged 18 and above who had been prescribed perampanel following either VNS implantation or surgical resection for the treatment of epilepsy. Main exclusion criteria were: patient’s medical records not being available for review and perampanel having been prescribed prior to surgical treatment being undertaken. Data were entered into the study database from each centre by delegated members of the direct care teams before being irretrievably anonymised and submitted to the Chief Investigator through approved NHS data sharing methods. Data were then pooled and statistical analyses performed Results: 149 people were studied: 81 female and 68 male. The mean age at onset of epilepsy was 13.3 years with a mean duration of 29.5 years. The majority of people included had undergone VNS implantation alone (95) with 36 having had previous surgery. 18 had undergone VNS implantation as well as resective surgery, VNS generally being implanted many years after the initial resective operation People included had previously tried many AEDs (average 5.75; SD = 3.77) prior to the introduction of perampanel and were taking a mean of 2.71 AEDs (SD 1.16) when perampanel was initiated. 57/132 patients (43.2%) experienced a decrease in seizure frequency after the introduction of Perampanel; 22 experienced an increase in seizure frequency and 53 showed no change compared to the six months prior to perampanel’s introduction, this being taken as a baseline. 79 patients (53%) were withdrawn from perampanel, most commonly owing to lack of benefit followed by adverse effect on mood. Conclusions: While perampanel improved seizure control in more than 40% of highly refractory cases, just over half of the cohort had this medication withdrawn. Further work is needed to determine optimal perampanel dosing in this group and to compare these data to long-term studies of perampanel efficacy in less pharmacoresistant people with epilepsy. On-going data mining may also identify factors that better predict responsiveness to perampanel. Funding: The study was sponsored by the Oxford University Hospitals NHS Foundation Trust and received funding from Eisai Limited.