Abstracts

Rationale: Perampanel, AMPA receptor antagonist has been utilized in patients with focal onset seizures and primary generalized tonic-clonic seizures in 12 years and older. The efficacy of perampanel in patients with Lennox-Gastaut syndrome (LGS) is unknown. We examined the efficacy and safety of perampanel in patients with LGS. Methods: To test whether perampanel had any impact on different pathological cause of epilepsy, a total of 15 patients collected from observational study were categorized into three groups [9 Partial onset seizures (POS), 4 LGS, 2 Traumatic Brain Injury (TBI)]. All patients were treated with perampanel in a community setting over 517 days (with median 457 days) of time period. Descriptive statistics, Wilcoxon signed rank test, and Kruskal Wallis test were performed. Seizure frequency was self-reported by patients or caregivers. The major purpose of the study was to determine median percent seizure reduction/28 days by these 3 groups.  Results: A total of 15 patients (Male: n=3, 20%); 9 POS, 4 LGS, and 2 TBI patients were included in the analysis. Mean age was 51.3 (SD 13.6; range 29 to 82 years).  Average years of epilepsy diagnosed was 8.6 years. Average number of concomitant AEDs when PER was initiated was 2.7. Patients were taking perampanel minimum 4mg to maximum 10mg/day when the study was cut-off. Median perampanel dose was 6mg with 4mg being a modal dose. Baseline median seizure frequency was 15 per 28 days. Post PER median seizure frequency was zero (mean 0.3) per 28 days. In POS group, the mean difference of seizure frequency was 12.7±5.4 (t=6.9; df=8; p=0.00). In LGS group, the mean difference of seizure frequency was 18±8.1 (t=4.4; df=3; p=0.02). In TBI group, the mean difference of seizure frequency was not statistically significant (Table 1). Overall, the mean difference of seizure frequency by 3 groups was not different from each other demonstrating that perampanel can be effective in treating with POS and LGS in this small population. No significant adverse side effects were reported in this patient population. One patient reported depression but the patient had preexisting depression before perampanel was added.  Conclusions: Perampanel demonstrated good efficacy in seizure frequency reduction in adult patients with POS and LGS.  Overall, median seizure frequency reduction in post perampanel treatment patients was 100% with 87% of seizure freedom in this small population. Larger observational studies with ample sample size will be warranted to validate the study outcome.  Funding: None