Abstracts

Rationale: Sleep disorders are common comorbidities in pharmacoresistant epilepsy. Both the amount as well as the quality of sleep are found to be altered in the epileptic population. Epileptic patients refer to excessive daytime sleepiness, poor sleep quality with the consequent impairment of their activities of daily life. Moreover, the sleep architecture is influenced by pharmacologic treatment. We hypothesize that there is a potential beneficial role in sleep-regulation of medicaments that block excitatory activity as perampanel. The primary objective of this study was to determine the sleep modulatory properties of perampanel in patients with focal epilepsies. Methods: We performed a prospective, monocentric pilot study in our comprehensive epilepsy center that included 19 patients aged 18 to 65 meeting criteria for refractory focal onset seizures (FOS). Patients were evaluated one week before PER-therapy with the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Inventory (PSQI) and a baseline polysomnography (PSG). PER tolerability was examined after titration. Four weeks after PER therapy was maintained at 6-8 mg/day, a 2nd PSG was performed altogether with PSQI and ESS. Results: 19 patients (9 females) were enrolled in the study. Until now, 13 patients performed the 2^ndPSG and 6 are ongoing. Average age was 39.4 years (range: 23-65). All patients presented focal onset epilepsy diagnosed through MVEEG. The evaluation of ESS revealed that patients with increased somnolence were reduced from 43 % previous PER to 30% after PER. The PSQI showed also changes pre and after PER: the global reduced sleep quality improved from 53% of patients to 30%; patients with reduced subjective sleep quality felt from 40% to 11%; increased sleep latency reduced from 47% to 22%; reduced sleep duration improved from 30% to 11%; reduced sleep efficiency changed from 47% to 11% of patients.The PSG analysis showed that the sleep latency was increased in 36% patients before PER and felt to 14% after PER. The sleep efficiency was reduced in 42% of cases and improved to 21% after PER; before PER, 63% of patients had > 10% Wake state while only 35% after therapy; 47% of patients presented > 10% WASO at first PSG and only 21% in the 2^nd PSG; Percentage of patients with increased N1 reduced from 31% to 12%; with reduced N2 from 58% to 40%; increased REM latency improved from 57% to 42%. Conclusions: This study reveals that perampanel seems to offer a favorable sleep modulatory effects in patients with focal onset seizures. This effect itself could play a protective role against the facilitation of seizures through sleep disorders. Funding: This study was supported by an international grant of EISAI Inc., but it was not involved in the analysis or interpretation of data.