Abstracts

Rationale: One third of people with epilepsy has medically refractory seizures, explaining the need for continued research into new interventions and therapies. Perampanel, which is a non-competitive selective antagonist at the postsynaptic ionotropic alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor, is a relatively new treatment for focal and generalized seizures. One of challenges for Perampanel to become more widely used is the limited experience of the neurological community with this medication. Methods: This is a retrospective study of 69 medically refractory patients, who have been prescribed Perampanel by at the UT Health San Antonio. Due to its long half-life and slower titration, we evaluated seizure outcome only in patients who had been on perampanel for at least three months. Side effects were described for all patients, but any increase in seizure frequency only in those patients who had been on the medication for at least one month. In our preliminary data analysis of 29 patients, we excluded 6 patients who were lost to follow up and 2 more patients were undergoing titration of neurostimulation settings, neither of whom complained of an adverse effect. Results: Four (19%) of our preliminary 29 patients discontinued the medication: 2 stopped taking Perampanel within 1 month due to concern of behavioral events and cognitive decline, 1 due to headache, and the fourth patient for unknown reasons. Seventeen (81%) patients (7 women, with mean epilepsy duration of 25 years) tolerated the medication well and were on perampanel (starting dose between 2-8 mg daily) for more than 15 months on average. Patients who have been using Perampanel for more than 3 months, eight patients had primary GTCS and 66% had a greater than 50% seizure reduction. Nine had focal epilepsy (86%), 8 demonstrated greater than 50% decrease in overall seizure counts. Eighteen (78%) of 23 patients, including the two patients with neurostimulation therapies, did not report any side effect. The remaining five patients reported mild form mood change (4 patients), dizziness (2 patients), and sleep walking (one patient). Conclusions: This retrospective case series demonstrates Perampanel’s therapeutic efficacy for controlling both focal and generalized seizure types.  Few patients discontinued the medication, and those with minor side effects continued to take Perampanel because of its efficacy. Funding: None