Abstracts

Rationale: Perampanel (PER) is an antagonist of AMPA receptors that has been approved for adjunctive treatment of partial-onset seizures [1,2]. We collected data of PER use as add-on treatment in routine clinical practice to explore effectiveness, safety, retention and seizure outcomes in different subgroups of patients with epilepsy Methods: PER was introduced as add-on treatment in 169 consecutive patients with drug-resistant focal epilepsy or epileptic encephalopathy. PER was started with 2 mg/day at bedtime and was up-titrated by 2 mg/day every 2-4 weeks. Demographics data, seizure semeiology, EEG pattern, MRI features and seizure frequency, responder rate and side effects were collected and reviewed. Results: After a mean follow-up of 12 months since PER initiation, the responder rate was 29%, including 8.1% seizure-free patients. Subgroup analysis showed that retention probability was higher in TLE patients compared with extratemporal subgroup. There was a tendency for higher retention probability with slow vs fast titration. Mean PER dose in the responders was 6.38 mg/day (range 4-10). Most common side effects were tiredness, behavioral changes (primarily irritability), dizziness and were reported in 33% of patients. Conclusions: PER as add-on treatment can achieve clinically meaningful improvement in patients suffering from severely refractory focal epilepsies [2]. These results warrant a change in the way PER is initiated by epileptologists and neurologists (slow titration, earlier add-on), to increase the likelihood that patients will remain on PER treatment over the long term (≥12 months). Further studies are warranted to explore the tolerability profile, with particular focus on psychiatric adverse events. [1] Rheims, S. and Ryvlin, P. (2013) Profile of  perampanel and its potential in the treatment of partial onset seizures.  Neuropsychiatr Dis Treat 9: 629–637.[2] French J., Krauss G., Steinhoff B., Squillacote D., Yang H., Kumar D. et al. (2013) Evaluation of adjunctive perampanel in patients with refractory partial-onset seizures: results of randomized global phase III study 305. Epilepsia 54: 117–125.  Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Eisai Inc.