Abstracts

Rationale: Despite multiple antiepileptic agents on the market, there remains a number of epilepsy syndromes resistant to therapy. Perampanel is a novel antiepileptic drug approved as adjunctive therapy for partial and primary generalized seizures in patients greater than 12 years of age. There are minimal reports exclusive to the pediatric population. The purpose of this study is to assess outcomes of perampanel in pediatric patients in a large comprehensive epilepsy center.   Of the patients included in this case report/study, 7 patients fall under this age cutoff, representing valuable data for potential use in future. Methods: Patients included in this single center, retrospective medical chart review were children (< 18 years) with epilepsy receiving perampanel between October 2012 and August 2016. Patients with known hypersensitivity to perampanel, severe hepatic or renal impairment, or pregnancy were excluded. The primary outcome was defined as a reduction in seizures greater than 50% from patient baseline. Secondary outcomes assessed safety and tolerability defined by the number of reported side effects and side effects requiring treatment discontinuation Results: Of 14 patients meeting study inclusion criteria 64% (N=9) received perampanel for intractable focal or multifocal epilepsy. The average patient age was 11 (range 4-17 years). Reduction in seizure burden greater than 50% was reported in 50% of patients (N=7). Discontinuation due to negative effect on seizure burden occurred in 14% (N=2) of patients. One of these patients had an autoimmune disorder, Rasmussen encephalitis and may have had subsequent disease progression. The second patient with negative seizure response received therapy for absence seizures. Severe treatment-emergent adverse events occurred in one patient, leading to discontinuation due to concern for polytherapy induced encephalopathy. An additional patient terminated therapy without mention of cause, though complaints of depressed mood, anxiety, and decreased energy may have led to preemptive discontinuation. The most common side effect was fatigue occurring in 14% of patients (N=2). Other reported side effects included cognitive dysfunction (N=1), ataxia (N=1) and aggression (N=1).  Conclusions: Overall perampanel was effective in seizure control and well tolerated with minimal treatment related side effects. Further controlled trials are warranted to better understand perampanel in this population. Funding: none