Abstracts

Rationale: Drug-resistant epilepsy occurs commonly in gliomas, possibly due to a shared mechanism of AMPA activation, involved in both tumor growth and epileptic activity. We tested the non-competitive AMPA-receptor blocker perampanel (PER) in patients with low- and high-grade gliomas and recurrent seizures. Methods: 12 patients with drug-resistant epilepsy were prospectively treated with PER. Inclusion criteria were: age over 18, glial tumor type, recurrent seizure activity at the time of initiating PER, failure on two or more anti-epileptic drugs (AEDs). Seizure response and severity was monitored by the NHS scale. Cognition was examined by CTCS (Computerized Test on Cognitive Speed) which measures reaction time and concentration.1, 2  Treatment policy included reduction of dose or a discontinuation of one or more concurrent AEDs, once a seizure response for 6 weeks or more was observed. Results: 12 patients were included patients, with a median age 41 years, 9 men vs 3 women. Tumor types: ganglioglioma 1, low-grade glioma 6, anaplastic glioma 3 and glioblastoma 2. Median number of AEDs taken at entry 4, varying between 2-5. Median duration of follow-up:  6 months. Objective seizure response was observed in 9 out of 12 patients:  50%-seizure response in 4, seizure-freedom in 5, unchanged in 2 and worse seizure activity in 1. Side-effects occurred in 6 patients: dizziness/vertigo in 4, drowsiness in 2. PER was withdrawn because of side-effects in one patient, because of lack of efficacy in another. Dose of concurrent AEDs was lowered in 2, lesser AEDs taken in 3, both lower dose and lesser AEDs taken in 3 and no change in the 4 others. Cognition as examined by CTCS was unchanged in 1/9, improved in 7/9, deteriorated in 1/9 and not tested in 3/12. Antiepileptic effects in patients on concurrent chemotherapy showed in 1/6 increased seizure activity with progressing tumor activity, 50%-seizure response in 2/6 of whom one showed progressing tumor activity, and seizure-freedom in 3/6. In patients not on concurrent chemotherapy, 2/6 responses were seen with either unchanged seizure activity, 50%-seizure response or seizure-freedom. Final median dose of PER: 8 mg, varying between 2 -12 mg. Conclusions: We observed an objective seizure response in 9 out of 12 patients treated by PER in drug-resistant epilepsy with low- and high-grade gliomas. Despite the occurrence of side-effects in 6 out of 12 patients, improvement of cognition was observed in 7 out of 9 tested patients. These results warrant randomized study with PER on seizure and tumor response in drug-resistant epilepsy with gliomas. Refs  1 Cancer Radiotherapie. 2013;17:413-8; 2 BMC Neurology. 2015; Dec 18;15:261-70 Funding: Non-Corporate study, No funding