Rationale:
Real-world data on efficacy and tolerability of antiseizure medicines (ASMs) help physicians on how newer medications perform in a clinical setting. We report our experience of prescribing Perampanel as monotherapy in treatment naïve patients to assess efficacy effectiveness and tolerability of Perampanel in new onset focal seizures.
Method:
We did a retrospective review of study patients with new onset focal epilepsy with or without secondary generalized seizures; ( using the latest ILAE 2017 seizure classification), aged ≥15 years, who had been prescribed Perampanel as monotherapy from July 2015 through December 2019. Treatment outcome included retention rate at observational point (OP) 3 (12 ± 3 months, seizure freedom rates at OP2 (6 ± 3 months) and adverse events (AEs).
Results:
Of 39 patients who enrolled in the study (Male : Female; 17:22, range 15-88 years old, average 46 years old), all had clinical diagnosis of new onset focal epilepsy confirmed with clinical seizure, EEG/video-EEG monitoring (VEM) and most had 24 hours VEM and MRI brain study. Thirty-nine cases were maintained on Perampanel monotherapy for the first 6 ± 3 months and the thirty-one patients maintained on Perampanel more than 1 years (two casesd were lost to follow up after six months and 6 cases were on Perampanel less than six months). The median Perampanel dosage was 4 mg (range 2-8 mg). At OP2, 79.0% (31/39 cases) onfirst-line monotherapy patients were seizure free. At OP3, 6 cases were excluded from analysis (2 cases loss follow up, 4 cases on Perampanel less than 6 months), the retention rates at OP3 was 70.0% (23/33 cases, 5 cases had intolerated AEs of Perampanel, 3 cases change to polytherapy because of uncontrolled seizure, 2 cases switching to other ASMs). Sixteen individuals (41%) had treatment-emergent adverse events, common AEs were dizziness, somnolence, ataxia, and only one case reported with depression. The AEs with somnolence and ataxia were found higher in patients > 60 years old (15% and 30%) than patients < 60 years old (7% and 3%), respectively. Only 14% (5 cases) intolerated adverse events and it was higher in patient >60 years old (23%).
Conclusion:
We report real world data, which show Perampanel to be efficacious and well tolerated with good retention rate as monotherapy in patients with new onset focal epilepsy in our cohort of patients.
Funding:
:No
FIGURES
Figure 1