Rationale:
Perampanel is a once-daily oral anti-seizure medication (ASM) for focal seizures and generalized tonic-clonic (GTC) seizures. There are limited data available on the use of perampanel for the treatment of patients with GTC seizures and myoclonic jerks. This case study reports the use of perampanel treatment in a patient with GTC seizures and myoclonic jerks who presented with uncontrolled seizures while being treated at Wayne Neurology.
Method:
Clinical visits occurred at Wayne Neurology, Michigan, USA. The initial visit occurred on September 14, 2018. A 30-year-old male patient was assessed for general characteristics, medical/seizure history, and clinical presentation, and monitored following perampanel initiation.
Results:
The patient, a smoker and occasional consumer of alcohol and marijuana, had a history of juvenile myoclonic epilepsy from 12 years of age (Table 1). The patient experienced monthly GTC seizures, and morning myoclonic jerks exacerbated by sleep deprivation. He was receiving valproate 500 mg orally, twice daily, and had never been seizure free. Perampanel was introduced to the treatment schedule to allow once-daily dosing in order to avoid breakthrough seizures and achieve better adherence, and for its low treatment burden, tolerability profile, and indication for primary generalized epilepsy. Other treatment options that were considered, but not used, included brivaracetam, clobazam, lamotrigine, and levetiracetam.
Perampanel 2 mg/day was initiated and maintained for 2 weeks, before being increased to 6 mg/day (final dose), when valproate was discontinued. Perampanel was taken orally, once daily at bedtime. The patient has now been seizure free for >12 months on perampanel, with rare morning jerks, enabling him to pursue a driver’s license. The patient was monitored for neurotoxic adverse events including agitation, ataxia, and somnolence; none were observed.
Conclusion:
GTC seizure freedom has been sustained since March 2019 in this adult male patient on perampanel monotherapy (6 mg/day), with no adverse events reported.
Funding:
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Funding:
: Medical writing support, under the direction of Dr Holtzman, was provided by Rebecca Furmston, PhD, of CMC AFFINITY, McCann Health Medical Communications, funded by Eisai Inc., in accordance with Good Publication Practice guidelines.
FIGURES
Figure 1