Abstracts

Rationale: To assess efficacy and tolerability of perampanel (PER), a noncompetitive AMPA receptor antagonist, as first add-on treatment in a real-world context, in patients non-responsive to first line therapy.  Methods: A retrospective, open label, multicentric study conducted in adult patients with focal and generalized seizures treated with PER at five Epilepsy Units located in Northern Italy, from June 2015 to March 2017. Patients were followed-up for at least 3 months and up to 1 year. Frequency of seizure and tolerability were assessed every 3 months. Patients had previously received one other antiepileptic treatment without significant improvement. Results: We enrolled 20 patients (M/F=10/10). Mean age was 36 years, with a mean duration of disease of 18.9 years.Three patients (15%) were affected by primary generalized epilepsy; 10 (50%) by focal epilepsy, and 7 (35%) by generalized and focal epilepsy. Eleven patients (55%) had idiopathic epilepsy, while 9 (45%) had a structural-metabolic aetiology. Two patients (10%) displayed an impaired cognition. Two (10%) patients had previously undergone epilepsy surgery.Mean seizure frequency at baseline was 18.2 seizure/month); three (15%) patients had daily seizures. Patients had previously taken 3.4 different AEDs, without efficacy.All patients were followed up for at least 3 months; 15 patients for 6 months, and 4 patients for 1 year. At the end of follow up, 50% of patients reported a 50% or greater reduction in seizure frequency; six (30%) were seizure free. Six (30%) patients reported a reduction lower than 50%. Mean dosage after 6 months was 7.2 mg.55% of patients reported at least one side effect, mainly somnolence (45%), vertigo/ataxia (5%), and sleep disturbances (5%). These lasted usually less than 3 months.Seven (35%) patients reduced or discontinued at least one other concomitant AED, while the EEG improved in 4 (20%). No patient withdrew PER during the study period.  Conclusions: These results suggest that PER is safe and well tolerated as a first add-on treatment in patient with epilepsy. Although this cohort of patients had various duration of follow-up, there was a general trend towards a good efficacy, with a particularly high frequency of patients achieving seizure freedom even with a short-term treatment. Although more than half of the patients experienced a side effect, these were usually transient and never led to discontinuation of treatment. More data are needed to confirm these preliminary findings. Funding: No fundings were received in support of this abstract