Abstracts

Rationale: Perampanel (PER) is a non competetiv AMPA receptor antagonist approved for adjunctive treatment of partial seizures with or without secondarily generalized seizure. PER was introduced in Denmark in september 2012. PER has a warning about the risk of neuropsychiatric events, including irritability, aggression and anger. Our study aimed to assess the incidence of aggression as a side effect in drug-resistant epilepsy patients with PER as add-on treatment. The aim of this study is 1) To assess the frequency of aggression in patients treated with PER in a ""real life"" clinical setting and investigate the concomitant medication. 2) To investigate if add on with PER in patients with mental retardation, have a higher risk of aggression.Methods: A cohort of 49 patients with refractory epilepsy prescribed PER as add on was followed. By review of medical records side effects were identified and analyzed. Our focus was on side effects and not on efficacy. Study population 49 patients with refractory epilepsy. 43 focal epilepsy. 6 multifocal epilepsy. 11 with mental retardation. Follow up: Range: 1 month – 2 years, 5 months. Median: 1 year. Dose: Range: 2-12 mg. Median: 6.6 mg. Concomitant medication: Lamotrigine: 17 Vigabatrine: 2 Levetiracetam: 17 Eslicarbazepine: 4 Clobazam: 12 Rufinamide: 2 Valproic acid: 9 Lacosamide: 16 Pregabalin: 4 Oxcarbazepine: 6 Topiramate: 6 Carbamazepine: 11 Sultiam: 2 Clonazepam: 3 Phenobarbital: 4 Retigabine: 1 Zonisamide: 3 VNS: 16Results: Out of 49 patients 12 patients (25%) experienced aggression as side effect to PER. The concomitant medication was: 1) Lamotrigine 2) Carbamazepine, lacosamide, clobazam 3) Topiramate, ospolot, valproic acid, VNS 4) Levetiracetam 5) Levetiracetam, valproic acid 6) Lacosamide, clobazam, VNS 7) Lamotrigine,clobazam 8) Valproic acid, levetiracetam, topiramate 9) Levetiracetam, clonazepam, carbamazepine 10) Levetiracetam, Lamotrigine, Clobazam, pregabalin, VNS 11) Lamotrigine, lacosamide, clobazam, VNS 12) Topiramate, valproic acid, ospolot, clobazam, VNS Patient karakteristica: 11 fokal epilepsy, 1 multifocal epilepsy Psychiatric comorbidity: 1 PTSD Mental retardation: 4 (2 severe, 2 moderate) In our cohort 12 (25%) patients experienced aggression as PER side effect. The mean dose of PER was 5.5 mg (range: 2-8 mg). PER was discontinued in 8 (67%) patients. 6 patients was treated with topiramate and after add on with PER 3 patients (50%) experienced aggression as side effect. 17 patients was treated with levetiracetam and after add on with PER 5 patients (29%) experienced aggression as side effect. 11 patients with mental retardation was treated with PER and 4 patients (36%) experienced aggression as side effect.Conclusions: Our data suggest that aggression might be a common side effect of PER treatment. Attention should be paid to the concomitant medications (particularly topiramate) and to co-morbidity with mental retardation when PER is introduced as add-on treatment.