Authors :
Presenting Author: Bo Kyu Choi, MD PhD – Gangnam Severance Hospital, Yonsei University College of Medicine
Hye Jeong Lee, MD PhD – Chung-Ang University Gwangmyeong Hospital
Yun Ho Choi, MD – The Cacholic university of korea, Incheon st. Mary's Hospital
Kyoung Jin Hwang, MD – Kyung Hee University Hospital, Kyung Hee University School of Medicine
Jung Bin Kim, MD PhD – Korea University Anam Hospital, Korea University College of Medicine
Hye-Rim Shin, MD PhD – Dankook University Hospital
Hee-Jin Im, MD PhD – Dongtan Sacred Heart Hospital, Hallym University Medical Center
Hyun-Woo Kim, MD PhD – Hyun Neurology Clinic
Jee Hyun Kim, MD PhD – Seoul Hospital, Ewha Womans University College of Medicine
Won-Joo Kim, MD PhD – Gangnam Severance Hospital, Yonsei University College of Medicine
Rationale:
Perampanel is a third-generation anti-seizure medication (ASM) that functions as a highly selective, noncompetitive alpha-amino-3-hydroxy-5-methyl-4-isooxazole-propionic acid (AMPA) receptor antagonist. Epilepsy treatment in the elderly presents unique clinical challenges; however, evidence specific to this population remains limited, and no studies to date have evaluated the use of perampanel in elderly patients in South Korea. This study evaluated the effectiveness and tolerability of perampanel as monotherapy or adjunctive therapy in elderly patients in Korea.
Methods:
Patient data were retrospectively collected from eight tertiary medical centers in South Korea where perampanel was administered. Treatment discontinuation, seizure frequency, and adverse events were assessed at 3, 6, 12, 24, and 36 months following perampanel initiation. Sub-analyses were performed according to treatment type: early add-on (≤1 prior anti-seizure medication), late add-on, or monotherapy. Continuous and categorical variables were compared among the groups using one-way analysis of variance and the Pearson χ² test, respectively.
Results:
The sample included 111 elderly patients (mean age: 72.1 ± 7.2 years), comprising 25 early add-on users, 64 late add-on users, and 22 monotherapy users. There were no significant differences in demographics, comorbidities, or epilepsy history among the treatment types. Retention rates at 3, 6, 9, 12, 24, and 36 months were 60.7%, 49.1%, 43.8%, 40.2%, 22.3%, and 16.1%, respectively. Among patients who discontinued within one year, the most common reason was loss to follow-up (n = 29), followed by adverse effects (n = 26) and death (n = 12). At 1, 2, and 3 years following perampanel initiation, the responder rates (defined as ≥50% reduction in baseline seizure frequency) were 83.9%, 80.0%, and 86.7%, respectively, while seizure freedom was achieved in 72.7%, 60.0%, and 66.7% of patients at each corresponding time point. When stratified by treatment type, the monotherapy and early add-on groups showed higher responder and seizure freedom rates compared to the late add-on group. Adverse effects were observed in 43 patients (38.4%). The most frequent events were sleep-related problems (14 cases) and dizziness (12 cases).
Conclusions:
This study demonstrated that although the retention rate of perampanel in elderly patients in Korea was somewhat lower compared to previous reports, the incidence of adverse effects was not high, indicating comparable safety. Notably, the responder rate remained high even over a long-term follow-up period of up to three years. These favorable outcomes were particularly evident in the monotherapy and early add-on groups, suggesting that perampanel may be a valuable treatment option in these patient populations.
Funding: None