Authors :
Presenting Author: Xuewu Liu, MD – Shandong First Medical University Affiliated Provincial Hospital
Cuihua Yan, MSc – Shandong First Medical University Affiliated Provincial Hospital
Ranran Zhang, MSc – Shandong First Medical University Affiliated Provincial Hospital
Anru Liu, MSc – Shandong First Medical University Affiliated Provincial Hospital
Lijun Wan, MSc – Shandong First Medical University Affiliated Provincial Hospital
Juntao Zhang, MSc – Shandong First Medical University Affiliated Provincial Hospital
Rationale:
Many patients with post-stroke epilepsy (PSE) exhibit a high rate of drug-resistant epilepsy. No established clinical treatment plan with a high retention rate currently exists that is both safe and effective for PSE. This study aims to evaluate the efficacy and safety of the AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazoleprop-ionic acid) , non-competitive inhibitor Perampanel as adjunctive therapy in patients with PSE, potentially offering a novel therapeutic option.
Methods:
This study employed a multi-center, prospective, open-label observational design. It included patients diagnosed with PSE who were admitted to the neurology departments of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Qilu Hospital of Shandong University, Qingdao University Affiliated Hospital, Zibo Changguo Hospital, the Third People's Hospital of Heze City, and Binzhou Medical College Affiliated Hospital during the period from May 2022 to February 2023. A decrease in seizure frequency of at least 50% or complete seizure cessation is defined as effective. The efficacy of Perampanel as adjunctive therapy for PSE was evaluated at 3, 6, and 12 months after treatment. The Kaplan-Meier method was used to generate survival curves and estimate the drug retention rate of Perampanel treatment. Factors influencing efficacy and adverse events(AEs) were explored using the Last Observation Carried Forward (LOCF) method.
Results:
A total of 93 patients were screened, of which 79 were included in the intent-to-treat analysis set. The treatment efficacy rates at 3, 6, and 12 months were 74.7%, 83.3%, and 86.2%, respectively. Corresponding seizure freedom rates were 49.3%, 56.1%, and 55.4%. Seizure type and stroke type are independent predictors of the efficacy of Perampanel as an add-on therapy. Patients with focal secondary bilateral tonic-clonic seizures exhibit a higher response to Perampanel compared to those with focal onset seizures, with or without impaired consciousness (P < 0.05). Additionally, the treatment effect is more pronounced in ischemic stroke patients than in those with hemorrhagic stroke (