Abstracts

Rationale: Epilepsy is one of the most common symptoms of brain tumours, is often drug resistant and patients can be forced to take polytherapy that can influence their quality of life (QoL) [Maschio M. Brain tumor-related epilepsy. Curr. Neuropharmacol. 2012;10(2):124-133].Pharmacotherapy of brain tumour-related epilepsy (BTRE) is complicated by possible loss of efficacy over time and potential interactions between anti-epileptic drugs (AEDs) and anticancer therapy, which may expose patients to an increased risk of adverse effects (AEs). Within this context, the second-generation AEDs are generally preferred over older-generation, in order to minimize the risks of adverse interactions [Perucca E. Optimizing antiepileptic drug treatment in tumoral epilepsy. Epilepsia. 2013;  54(Suppl.9):97-104]. Perampanel (PER) is a new AED used as adjunctive therapy in patients with partial seizures with or without secondary generalization [Steinhoff BJ, Ben-Menachem E, Ryvlin P, Shorvon S, Kramer L, Satlin A, Squillacote D, Yang H, Zhu J, Laurenza A. Efficacy and safety of adjunctive perampanel for the treatment of refractory partial seizures: a pooled analysis of three phase III studies. Epilepsia. 2013; 54(8):1481-1489]. The aim of this study was to evaluate, for 12 months, efficacy, tolerability and impact on QoL of PER as add-on in BTRE patients with uncontrolled seizures. Methods: To data we recruited 30 patients followed in two Departments in Italy (Rome and Napoli). Baseline data (before PER introduction) included tumour history and therapy, evaluation of type and seizures frequency, previous AEDs and administration a battery of QoL tests. Seizure count, change in dosage of PER, AEs and QoL evaluation were recorded at six and at finally follow-up (12 months). Results: To data we have recruited 30 patients (20 males, mean age 47 years) followed for 6 months: fifteen low-grade glioma and 15 high-grade glioma. During follow-up with PER therapy eleven were in chemotherapy. Six patients dropped out: one for scarce compliance, 2 for disease progression and 3 for side effects. All patients had partial seizures, with (11 patients) or without (19 patients) secondarily tonic-clonic generalization. Fifteen patients were receiving AEDs monotherapy. The mean daily PER dosage was 7.4 mg. The mean number of seizures/month decreased from 11.3±14.4 at baseline to 2.9±6.6 at six months. Responder rate was 84.6%: seven were seizure-free, 15 had a seizure reduction =50%, 1 had seizure reduction <50% and seizure frequency worsened in 1 patient. Eight patients reported AES: 1 required PER dose reduction and 3 discontinued the study (1 anger and 2 vertigo). The evaluation of QoL tests at 6 and 12 months is ongoing. Conclusions: Our preliminary data, indicate that PER, as add-on, in patients with BTRE, seems to have a good efficacy on seizure control and seems to be quite well tolerated.  Funding: None