Abstracts

Rationale: Perampanel (PER) is a selective, noncompetitive AMPA receptor antagonist with demonstrated efficacy and tolerability in partial seizures with or without secondarily generalized seizures in patients aged ?-12 years. Our study was conducted to analyze the efficacy and tolerability of PER as add-on treatment in patients with severely refractory focal epilepsy at 6 months of follow-up. Methods: PER was introduced as add-on treatment in consecutive 16 patients with severely refractory focal epilepsy with or without secondary generalization. Patients were included if they were 12 years or older at the time of PER introduction, had at least 1 year of drug resistance despite a stable regimen of at least 2 AEDs, and had more than 1 seizure for week. PER was started with 2 mg/day, it was up-titrated by 2 mg/day every 2 weeks to obtain a maintenance dose from 4 to 6 mg/d. The efficacy and tolerability of PER was analyzed in patients with 6 months of chronic exposure. Results: All patients of this study took PER regularly. Overall rate of adverse effects was 25%, by including irritability (2 patients, 12.5%) and dizziness (2 patients, 12.5%). PER discontinuation was made for both patients showing irritability, although they showed seizure free and EEG normalization immediately afterwards they took 4 mg of PER. In the remaining 14 patients, 6 months after PER initiation, 21.4% subjects had seizure free, 50% had a reduction of seizures frequency > 50%, and 14.3% a reduction of 30%. Two patients didn't show any benefits. Mean PER dose was 5.28 mg/day (range 4-6). 5 patients had MRI negative, 4 of them (80%) were seizure free with 4 mg of PER and 1 (20%) had a reduction of seizures frequency > 50%. Conclusions: PER as add-on treatment can achieve clinically meaningful improvement in patients suffering from severely refractory focal epilepsy, especially in MRI-negative cases. Since patients showing irritability become seizure free with EEG normalization immediately afterwards they took 4 mg of PER, we could to speculate that the irritability was an secondary effect of forced EEG normalization rather than a true PER event adverse. Funding: The authors received no financial support for the research, authorship, and/or publication of this Abstract.