Abstracts

Rationale: Irritability has been described as a frequent adverse event in patients affected by epilepsy and treated with Perampanel (PER), Levetiracetam (LEV), and Valproic Acid (VPA). In the past years forced normalization has been associated with psychiatric manifestations in patients who completely resolved epileptiform discharges after starting the antiepileptic treatment. Since the questionnaire for irritability (I-EPI) is a validated instrument to measure this psychiatric manifestation in patients affected by epilepsy, in this study we aimed at investigating the effect of PER as first add-on therapy on quantitative EEG (qEEG) and I-EPI in patients affected by secondarily generalized seizures (SGS) and seizure free at the three-month follow-up (FU). Moreover, we compared I-EPI of patients treated by PER obtained at FU with that of patients successfully treated by LEV and VPA in order to measure irritability as a consequence of these treatments. Methods: We included in this analysis adult patients affected by uncontrolled SGS who reached seizure freedom at FU after starting PER as first add-on therapy (4 mg/day). All patients underwent qEEG and I-EPI at baseline (before starting PER treatment) and FU. As control groups for I-EPI we reviewed clinical charts of age and sex matched patients affected by epilepsy who were seizure freedom at FU after starting VPA (600 mg/day long-release) or LEV (1000 mg/day) as first-add on treatments. Results: We included 12 patients treated by PER in this analysis. We did not document significant changes of I-EPI between baseline and FU in the PER group. The qEEG analysis showed the increase in alpha band relative power with the reduction of delta band relative power in the posterior brain regions (O1, O2). Globally, brain delta band relative power reduced with increase of theta and alpha bands relative power. As concerning the comparison of I-EPI among PER, LEV (n=18), and VPA (n=16) groups, we documented lower total score in patients treated by PER than both LEV (p<0.05) and VPA (p<0.05). Conclusions: This pilot study documents that patients affected by SGS successfully treated by PER as first add-on therapy present a lower degree of irritability than LEV and VPA. Moreover, qEEG analysis shows in patients treated by PER a global increase in alpha band relative power, more evident in the occipital regions, coupled with a reduced relative power of delta and theta bands.In conclusion, irritability seems to not be a frequent complaint in patients affected by SGS successfully treated by a low dose of PER, which impacts on qEEG by increasing alpha band relative power, as a possible effect of the brain EEG rhythms normalization. Funding: This study received a research grant support from EISAI.