Abstracts

Rationale: Perampanel (PER), a selective, non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, is approved for adjunctive treatment of focal seizures with or without secondarily generalized seizures (2GTCS) and for primary generalized tonic–clonic seizures in patients with epilepsy aged ≥12 years. Perampanel was recently approved for monotherapy use for focal seizures in the U.S.A. This study provides insight into the feasibility of perampanel monotherapy in new onset focal epilepsy in real-world settings. Monotherapy is generally associated with less toxicity, better compliance, and low cost. Methods: The retrospective study patients with new onset focal epilepsy who had perampanel monotherapy from July 2015 through June 2019. Of 27 patients who enrolled in the study (Male : Female; 9:18, range 14-88 years old, average 52 years old), all had clinical diagnosis of new onset focal epilepsy confirmed with EEG and MRI brain.   Results: Twenty-three patients were maintained on perampanel monotherapy 1-4 years, only 4 patients on PER less than a year. Seizure data were available for 27 patients, of whom 19 patients (70%) became seizure-free, 5 patients had ≥50% seizure reduction, 2 patients had >75% seizure reduction, but one patient had seizure increased. Three patients had to change to use duotherapy further for better seizure control. Eight patients had 2GTCS prior enrolled to the study, but none had further 2GTCS since on perampanel. Thirteen individuals (48%) had treatment-emergent adverse events, the most frequent was dizziness, ataxia, and somnolence. Four patients (14%) had in tolerated adverse event and one had to withdraw the medication because the medication was not covered by medical care insurance.     Conclusions: This study may provide an insight into the feasibility of perampanel monotherapy in new onset focal epilepsy. The results indicate that perampanel might be useful as a monotherapy in new onset focal epilepsy. About 70% of the cases became seizure-free. None had further 2GTCS since on the perampanel. However, dizziness, ataxia, and somnolence are common adverse event (48%) and some cases might be intolerated to these adverse events.    Funding: No funding