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Yue X, Liu XM, Chen J, Chen HY, Tan QQ, Zhou Y. The Efficacy and Cognitive Impact of Perampanel Monotherapy in Patients with Self-Limited Epilepsy with Centrotemporal Spikes: A Retrospective Analysis. Neuropsychiatr Dis Treat 2023; 19:1263-1271. [PMID: 37274142 PMCID: PMC10237329 DOI: 10.2147/ndt.s410858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Objective The third generation of antiepileptic medication (ASM) perampanel (PER), is mostly used as an add-on treatment for refractory epilepsy patients, and rarely used as a monotherapy. This study aims to observe the efficacy and assess the cognitive effects of PER monotherapy in patients with self-limited epilepsy with centrotemporal spikes (SeLECTS). Patients and Methods Through screening, 86 patients who were first diagnosed with SeLECTS and treated with PER monotherapy were included in this study. All patients were followed up at least 12 months, and Evaluated the efficacy and safety of PER by observing the seizures of patients. At the same time, we used the P300 event-related potential (ERP) component and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) to evaluate the cognitive changes in children before and after treatment with PER. Results Ten percent of the children experienced adverse effects, such as dizziness, gait instability, and irritability. The drug retention rate at the last follow-up was 98.83%. Further more, the P300 ERP component and WISC-IV tests were performed no significant difference before and 12 months after PER monotherapy in SeLECTS children. Conclusion The third-generation of ASM PER monotherapy had a clear effect in children with SeLECTS. A small dose of PER can control seizures well and has no obvious effect on cognitive development.
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Affiliation(s)
- Xuan Yue
- Department of Neurology, XuZhou Children’s Hospital, XuZhou, People’s Republic of China
| | - Xiao-Ming Liu
- Department of Neurology, XuZhou Children’s Hospital, XuZhou, People’s Republic of China
| | - Jiao Chen
- Department of Neurology, XuZhou Children’s Hospital, XuZhou, People’s Republic of China
| | - Hai-Yun Chen
- Puluo (Wuhan) Medical Biotechnology Co., LTD, Wuhan, People’s Republic of China
| | - Qian-Qian Tan
- Puluo (Wuhan) Medical Biotechnology Co., LTD, Wuhan, People’s Republic of China
| | - Yong Zhou
- Puluo (Wuhan) Medical Biotechnology Co., LTD, Wuhan, People’s Republic of China
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Hou L, Yang J, Zhang X, Li N, Li S, Zhang L, Zhao J, Wang Q. Efficacy and tolerability of perampanel in patients with seizures in real-world clinical practice: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1139514. [PMID: 37056989 PMCID: PMC10086234 DOI: 10.3389/fphar.2023.1139514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives: The aim of this study was to systematically review the efficacy and tolerability of perampanel (PER) when used as add-on treatment or monotherapy in patients with epilepsy aged 12 years and older in routine clinical practice.Methods: Electronic and clinical trials databases were searched for observational studies of PER published up to 1 March 2022. The outcomes of interest were responder rates, adverse effects (AEs), and withdrawal rates. Subgroup analyses were performed to explore the potential factors that might affect the efficacy and safety of PER usage.Results: A total of 56 studies, which included 10,688 patients, were enrolled. The results showed that after 3, 6, and 12 months of PER treatment, the pooled 50% responder rates in patients with epilepsy were 50.0% (95% CI: 0.41–0.60), 44.0% (95% CI: 0.38–0.50), and 39.0% (95% CI: 0.31–0.48), respectively, and the pooled seizure-free rates were 24.0% (95% CI: 0.17–0.32), 21.0% (95% CI: 0.17–0.25), and 20.0% (95% CI: 0.16–0.24), respectively. Subgroup analyses revealed that the efficacy of PER could be affected by the way in which PER is administrated. Patients in the groups where PER was used as the first add-on, primary monotherapy, or combined with non–enzyme-inducing AEDs (non-EIAEDs) displayed a high 50% responder rate and seizure-free rate when compared with those in the late add-on, conversion therapy, or combined with the EIAEDs groups, respectively. Furthermore, the incidences of AEs at 3, 6, and 12 months of PER treatment were 46% (95% CI: 0.38–0.55), 52.0% (95% CI: 0.43–0.60), and 46.0% (95% CI: 0.40–0.52), respectively. The withdrawal rates due to AEs were 8.0% (95% CI: 0.06–0.11), 16.0% (95% CI: 0.13–0.20), and 16% (95% CI: 0.11–0.21) at 3, 6, and 12 months of PER treatment, respectively. Subgroup analyses showed a higher withdrawal rate in the rapid (30%, 95% CI: 0.22–0.38) than in the slow (12%, 95% CI: 0.06–0.18) titration group.Conclusion: Altogether, PER was effective and could be fairly tolerated in both short-term and long-term usage in patients with epilepsy in routine clinical practice. Furthermore, PER appeared to be more effective when PER was used as the first add-on, monotherapy, or concomitant with non-EIAEDs.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384532.
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Affiliation(s)
- Liyan Hou
- Dalian Medical University Library, Dalian Medical University, Dalian, China
| | - Jingjing Yang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xuan Zhang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Na Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Sheng Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Lei Zhang
- Dalian Medical University Library, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Jie Zhao
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Qingshan Wang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- School of Public Health, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
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Estévez-María JC, Garamendi-Ruiz I. The real-world effectiveness and safety of perampanel in Europe: A scoping review. Epilepsy Behav 2022; 134:108777. [PMID: 35816832 DOI: 10.1016/j.yebeh.2022.108777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022]
Abstract
In order to characterize the real-world effectiveness and safety of perampanel during clinical use in Europe, we conducted a structured literature search and scoping review of real-world studies conducted in Europe in adolescents (aged ≥ 12 years) or adults who were prescribed perampanel for focal epilepsy or primary generalized tonic-clonic seizures in the context of idiopathic generalized epilepsy, published between January 2016 and July 2021. We identified 29 relevant studies (20 retrospective and 9 prospective) in 3608 patients; median study duration was 12 months. Most patients (76.1%) were receiving two or more antiseizure drugs (ASDs) when perampanel was initiated. The maintenance perampanel dose ranged from 2 to 16 mg/day (most commonly 6 mg/day). Retention rate at 12 months ranged from 46% to 90.5% (median 71.1%). The proportion of patients who were free of seizures during perampanel ranged from 1.8% to 84.6%, but were consistently below 20% in studies where patients had received an average of ≥5 prior ASDs and above 20% where patients had received an average of <5 prior ASDs. The proportion of patients who achieved ≥50% reduction in seizures during perampanel ranged from 20.0% to 85.7%. Across all studies, the incidence of adverse events (AEs) ranged from 18.2% to 67.4% (median 37.1%) and discontinuation due to AEs from 6.2% to 56% (median 12.5%). Discontinuation rates tended to be higher in UK studies than in studies from Italy or Spain. The most commonly reported individual AEs were dizziness/vertigo (median incidence 13.7%), somnolence (median 11.9%), aggression (median 9.8%), irritability (median 9.1%), and cognitive deficits (median 7.0%). There was no relationship between the overall rate of AEs and perampanel dose, perampanel plasma levels, or number of concomitant medications. Our global overview of European observational studies with perampanel provides evidence that this agent is effective and safe in clinical practice in a range of countries, patients, and settings.
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Zhou DJ, Pavuluri S, Snehal I, Schmidt CM, Situ-Kcomt M, Taraschenko O. Movement disorders associated with antiseizure medications: A systematic review. Epilepsy Behav 2022; 131:108693. [PMID: 35483204 PMCID: PMC9596228 DOI: 10.1016/j.yebeh.2022.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
New-onset movement disorders have been frequently reported in association with the use of antiseizure medications (ASMs). The frequency of specific motor manifestations and the spectrum of their semiology for various ASMs have not been well characterized. We carried out a systematic review of literature and conducted a search on CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus from inception to April 2021. We compiled the data for all currently available ASMs using the conventional terminology of movement disorders. Among 5123 manuscripts identified by the search, 437 met the inclusion criteria. The largest number of reports of abnormal movements were in association with phenobarbital, valproic acid, lacosamide, and perampanel, and predominantly included tremor and ataxia. The majority of attempted interventions for all agents were discontinuation of the offending drug or dose reduction which led to the resolution of symptoms in most patients. Familiarity with the movement disorder phenomenology previously encountered in relation with specific ASMs facilitates early recognition of adverse effects and timely institution of targeted interventions.
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Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Spriha Pavuluri
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Isha Snehal
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cynthia M Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, United States
| | - Miguel Situ-Kcomt
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States.
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Fernandes M, Dainese F, Operto F, Lattanzi S, Matricardi S, Renna R, Placidi F, Paladin F, Pastorino GMG, Foschi N, Cesaroni E, Mercuri NB, Liguori C. Perampanel effectiveness and tolerability in patients with epilepsy at long-term follow-up. Epilepsy Behav 2021; 121:108069. [PMID: 34077902 DOI: 10.1016/j.yebeh.2021.108069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/22/2021] [Accepted: 05/09/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The main of the present study was to assess the effectiveness and tolerability of perampanel (PER) in association with 1 or 2 concomitant antiseizure medications (ASMs) in patients with epilepsy throughout a follow-up period of 24 months or longer in a real-world setting. METHODS This retrospective, observational, multi-center study collected data from both underage (<18 years old) and adult patients who had started PER in association with 1 or 2 ASMs. Only patients who had started PER and were followed up for at least 24 months were included. Response to treatment was analyzed at the 24-, 36-, and 48-month visits by considering the last visit undergone by patients. Subgroup analyses were performed according to age, gender, and epilepsy type and patients were categorized following PER treatment in concomitance with 1 or 2 ASMs to evaluate the factors affecting the achievement of seizure freedom (SF) at the 24-month FU. RESULTS Ninety-four patients were included (mean age 36.89 years; 51.1% female). At the 24-month follow-up visit, 90 (95.74%) patients were still receiving PER concomitantly with 1 or 2 ASMs. The mean PER dose was 6.02 mg/day and SF was achieved by 33 (35.1%) patients. A significantly higher SF rate was found in patients who had started PER with only 1 ASM when compared to those who had started PER with 2 concomitant ASMs. Effectiveness was maintained also in the subgroups of patients with a 36- or 48-month follow-up visit. Adult patients had a higher final daily dosage of PER than underage patients. Logistic regression found that the lowest number of previously failed ASMs was associated with a higher SF rate (p = 0.036). CONCLUSION Perampanel demonstrated a good effectiveness in association with 1 or 2 ASMs in both pediatric and adult patients, without having to use a high dose of the drug. The possibility to present SF was higher when PER was added early. Finally, the maintenance of effectiveness was observed also in the subgroups of patients with a follow-up of 36 and 48 months.
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Affiliation(s)
- Mariana Fernandes
- Epilepsy Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy; Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Filippo Dainese
- Epilepsy Centre, Neurologic Unit, SS.Giovanni e Paolo Hospital, Venice, Italy
| | - Francesca Operto
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Children's Hospital "G. Salesi", Ospedali Riuniti Ancona, Italy
| | - Rosaria Renna
- Neurological Clinic and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy; Outpatient Clinic for Epilepsy, "A. Cardarelli" Hospital, Naples, Italy
| | - Fabio Placidi
- Epilepsy Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy; Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Francesco Paladin
- Epilepsy Centre, Neurologic Unit, SS.Giovanni e Paolo Hospital, Venice, Italy
| | | | - Nicoletta Foschi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Elisabetta Cesaroni
- Department of Child Neuropsychiatry, Children's Hospital "G. Salesi", Ospedali Riuniti Ancona, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Claudio Liguori
- Epilepsy Centre, Department of Systems Medicine, University of Rome 'Tor Vergata", Rome, Italy; Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.
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Sagar P, Wawryk O, Vogrin S, Whitham E, Kiley M, Frasca J, Carne R, Seneviratne U, Cook MJ, Lawn N, Nikpour A, D'Souza WJ. Efficacy and tolerability of adjuvant perampanel: an Australian multicenter real-world observational study in refractory focal and generalized epilepsy syndromes. Epilepsy Behav 2021; 119:107935. [PMID: 33930626 DOI: 10.1016/j.yebeh.2021.107935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the efficacy and tolerability of adjuvant perampanel (PER) and their associated risk factors in late add-on drug-resistant epilepsy. METHOD Retrospective multicenter 'real-world' observational study. Consecutively identified patients commenced on PER, with mixed epilepsy syndromes, from nine Australian epilepsy centers. Primary efficacy endpoints were at least 50% reduction in seizure frequency (responders), seizure freedom, and retention at 6 and 12 months, following a 3-month titration period. Tolerability endpoints were cessation of PER for any reason, cessation of PER due to treatment-emergent adverse events (TEAE), or cessation due to inefficacy. Outcomes were assessed for a-priori risk factors associated with efficacy and tolerability. RESULTS Three-hundred and eighty seven adults were identified and followed up for a median of 12.1 months (IQR 7.0-25.2). Focal epilepsy accounted for 79.6% (FE), idiopathic generalized epilepsy (IGE), 10.3% and developmental epileptic encephalopathy (DEE) 10.1%, of the cohort. All patients had drug-resistant epilepsy, 71.6% had never experienced six months of seizure freedom, and the mean number of antiepileptic medications (AEDs) prior to starting PER was six. At 12 months, with missing cases classified as treatment failure, retention was 40.0%, responder 21.7%, and seizure freedom 9.0%, whereas, using last outcome carried forward (LOCF), responder and seizure freedom rates were 41.3% and 14.7%, respectively. Older age of epilepsy onset was associated with a marginal increase in the likelihood of seizure freedom at 12-month maintenance (OR 1.04, 95% CI 1.02, 1.06). Male sex (adjusted OR [aOR] 2.06 95% CI 1.33, 3.19), lower number of prior AEDs (aOR 0.84, 95% CI 0.74, 0.96) and no previous seizure-free period of at least 6-month duration (aOR 2.04 95% CI 1.21, 3.47) were associated with retention. Perampanel combined with a GABA receptor AED was associated with a lower responder rate at 12 months but reduced cessation of PER. The most common TEAEs were neuropsychiatric (18.86%), followed by dizziness (13.70%), and sleepiness (5.68%). CONCLUSIONS Adjuvant PER treatment, even in late-add on drug-resistant epilepsy is an effective and well-tolerated treatment for drug-resistant epilepsy.
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Affiliation(s)
- Parveen Sagar
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | - Olivia Wawryk
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Emma Whitham
- Department of Neurology, Flinders Medical Centre, Australia
| | - Michelle Kiley
- Department of Neurology, Royal Adelaide Hospital, Australia
| | - Joseph Frasca
- Department of Neurology, Flinders Medical Centre, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia
| | - Mark J Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Armin Nikpour
- Department of Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Wendyl Jude D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
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Stephen L, Brodie MJ. Adjunctive brivaracetam - A prospective audit of outcomes from an epilepsy clinic. Epilepsy Behav 2021; 116:107746. [PMID: 33517200 DOI: 10.1016/j.yebeh.2020.107746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Brivaracetam (BRV), is licensed in Europe as adjunctive treatment, and in the United States of America as adjunctive and monotherapy for focal seizures with or without secondary generalization in adults, adolescents, and children ≥4 years. As BRV becomes available globally, this prospective audit was undertaken to gain an understanding of how best to use the anti-seizure medication (ASM) in the everyday clinical setting. METHODS Brivaracetam was started by patients ≥16 years with difficult-to-control epilepsy at Glasgow epilepsy clinics following a 12-week baseline on stable ASM doses. Target dosing was 200 mg/day. Review occurred every 12-16 weeks until 1 of 4 end-points occurred: seizure freedom for ≥6 months on a given BRV dose; ≥50% (responder) or <50% (marginal benefit) seizure reduction over 6 months compared with baseline on the highest tolerated BRV dose; withdrawal of BRV due to lack of efficacy, adverse effects, or both. RESULTS An end-point has been reached by 108 patients (38 men, 70 women; median age 45 years), 88 with focal-onset seizures and 20 with genetic generalized epilepsies (GGEs). Of these, 71 (65.7%) have benefitted from BRV, including 23 (21.3%) who have been seizure free for ≥6 months on a median BRV dose of 100 mg/day (range 25-200 mg/day). A further 18 (16.7%) were classified as responders and 30 (27.8%) showed marginal benefit. Brivaracetam benefitted 16 (80.0%) patients with GGEs, 5 becoming seizure free. Generalized tonic-clonic seizures, absences, and myoclonic seizures were completely controlled in 4 (25%) patients with juvenile myoclonic epilepsy. Brivaracetam monotherapy was established in 12 patients, 3 of whom had GGEs. Levetiracetam (LEV) had previously been prescribed in 53 patients who had discontinued the ASM due to lack of efficacy, side effects, or both. Adjunctive BRV benefitted 34 (64.2%) of these patients. Brivaracetam was withdrawn in 37 (34.3%) patients, (23 side effects, 4 lack of efficacy, 10 both). Sedation was the commonest side effect leading to BRV withdrawal (n = 14; 13.0%). Psychiatric side effects resulted in BRV discontinuation in 9 (8.3%) patients. SIGNIFICANCE Brivaracetam has efficacy for a range of seizure types and syndromes in a wide range of doses. The ASM can produce positive outcomes in patients who have failed LEV. Post-marketing studies remain a useful tool to evaluate the efficacy and tolerability of novel ASMs in everyday clinical practice.
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Affiliation(s)
- Linda Stephen
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, United Kingdom.
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Motomura K, Chalise L, Shimizu H, Yamaguchi J, Nishikawa T, Ohka F, Aoki K, Tanahashi K, Hirano M, Wakabayashi T, Natsume A. Intraoperative seizure outcome of levetiracetam combined with perampanel therapy in patients with glioma undergoing awake brain surgery. J Neurosurg 2021; 135:998-1007. [PMID: 33482638 DOI: 10.3171/2020.8.jns201400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of levetiracetam (LEV) combined with perampanel (PER) therapy for intraoperative seizure treatment to determine whether a combination of LEV and PER can aid in the prevention of intraoperative intractable seizures during awake surgery. METHODS The authors performed a retrospective cohort study in 78 consecutive patients with glioma who underwent awake surgery using intraoperative direct electrical stimulation mapping. To prevent intraoperative seizures, 50 patients were treated with the antiepileptic drug LEV only (LEV group) from January 2017 to January 2019, while the remaining 28 patients were treated with LEV plus PER (LEV + PER group) between March 2019 and January 2020. LEV (1000-3000 mg) and/or PER (2-4 mg) were administered before the surgery. RESULTS Preoperative seizures with International League Against Epilepsy (ILAE) class II-VI occurred in 44% of the patients in the LEV group and in 35.7% of patients in the LEV + PER group, with no significant difference between groups (p = 0.319). Total intraoperative seizures occurred in 18 patients (36.0%) in the LEV therapy group and in 2 patients (7.1%) in the LEV + PER group (p = 0.009). Of these, there were no patients (0%) with intractable seizures in the LEV + PER group. Regarding factors that influence intraoperative seizures in glioma patients during awake brain surgery, multivariate logistic regression models revealed that the occurrence of intraoperative seizures was significantly related to the involvement of motor-related regions (positive vs negative, HR 6.98, 95% CI 1.71-28.56, p = 0.007), preoperative seizure (ILAE class II-VI vs ILAE class I, HR 4.44, 95% CI 1.22-16.11, p = 0.024), and LEV + PER group (positive vs negative, HR 0.07, 95% CI 0.01-0.44, p = 0.005). Treatment-related adverse effects were rare and mild, including sleepiness, tiredness, and dizziness in both treatment groups. CONCLUSIONS This study demonstrates that LEV + PER therapy is significantly associated with a lower risk of intraoperative seizures compared with LEV therapy alone in patients with glioma during awake brain mapping. These findings will help neurosurgeons conduct safe and reliable awake surgeries and reduce the rate of intraoperative intractable seizures during such procedures.
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Peng X, Yan Y, Chen R, Wang X, Xu X. Long-term safety, tolerability, and efficacy of magnesium valproate versus sodium valproate in acute seizures. Curr Med Res Opin 2020; 36:271-276. [PMID: 31775535 DOI: 10.1080/03007995.2019.1699520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the safety, tolerability and efficacy of magnesium valproate and sodium valproate as monotherapies in patients with epilepsy in China.Methods: We recruited patients admitted with seizures over a two-year period. All patients underwent early neurological assessments, electroencephalogram testing, and neuroimaging. The treatments received at baseline and at one year of follow-up were compared.Results: In total, 175 patients were included. The retention rates of the magnesium valproate and sodium valproate treatments were 73.1% and 64.2%, respectively. The main cause of discontinuation was the development of intolerable adverse events. The retention rate and total effective rate in the magnesium valproate group were significantly higher than those in the sodium valproate group (73.1% and 70.2% versus 64.2% and 47.2%, respectively). The safety endpoints included 120 patients (magnesium valproate: n = 67; sodium valproate: n = 53). The incidence of adverse events in the magnesium valproate group was significantly lower than that in the sodium valproate group (30% versus 51%).Conclusions: Magnesium valproate treatment shows favorable safety and tolerability and is associated with markedly improved seizure control. Ideally, future large, prospective, randomized, and double-blind studies are needed to confirm these findings.
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Affiliation(s)
- Xiaoyan Peng
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yin Yan
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Xu
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Common genetic generalised epilepsy syndromes encountered by clinicians include childhood and juvenile absence epilepsies, juvenile myoclonic epilepsy and generalised tonic-clonic seizures on awakening. Treatment of these syndromes involves largely the use of broad-spectrum antiseizure drugs. Those effective for the generalised epilepsies include sodium valproate, phenobarbital, ethosuximide, clobazam, clonazepam, lamotrigine, levetiracetam, topiramate, zonisamide and, more recently, perampanel and brivaracetam. Results from the few rigorous studies comparing outcomes with drugs for genetic generalised epilepsies show valproate to be the most effective. The majority of patients with genetic generalised epilepsy syndromes will become seizure free on antiseizure monotherapy; those for whom control proves elusive may benefit from combination regimens. Early counselling regarding management may assist the patient to come to terms with their diagnosis and improve long-term outcomes. Treatment can be lifelong in some individuals, although others may remain seizure free without medication. Choice of antiseizure medication depends on the efficacy for specific seizure types, as well as tolerability. For patients prescribed comedication, drug interactions should be considered. In particular, for young women taking oral hormonal contraceptives, ≥ 200 mg/day of topiramate can decrease the circulating concentration of ethinylestradiol and ≥ 12 mg/day of perampanel can induce levonorgestrel metabolism. The use of valproate in women of childbearing potential is limited by associated teratogenic and neurodevelopmental effects in offspring. Given that valproate is often the antiseizure drug of choice for genetic generalised epilepsies, this creates a dilemma for patients and clinicians. Decision making can be aided by comprehensive assessment and discussion of treatment options. Psychiatric comorbidities are common in adolescents and adults with genetic generalised epilepsies. These worsen the prognosis, both in terms of seizure control and quality of life. Attendant lifestyle issues can impact significantly on the individual and society. Frontal lobe dysfunction, which can present in patients with juvenile myoclonic epilepsy, can adversely affect the long-term outlook, regardless of the nature of seizure control. Ongoing management requires consideration of psychosocial and behavioural factors that can complicate diagnosis and treatment. An assured supportive attitude by the neurologist can be an important contributor to a positive outcome. The mechanisms underlying genetic generalised epilepsies, including genetic abnormalities, are unclear at present. As the pathophysiology is unravelled, this may lead to the development of novel therapies and improved outcomes for patients with these syndromes.
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Affiliation(s)
- Linda J Stephen
- West Glasgow Ambulatory Care Hospital, Dalnair St, Glasgow, G3 8SJ, UK.
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Abril Jaramillo J, Estévez María JC, Girón Úbeda JM, Vega López Ó, Calzado Rivas ME, Pérez Díaz H, García Martín G, Vila Herrero E, Chamorro-Muñoz M, Vázquez F, De la Fuente C, Redondo L, Peláez N, Santágueda P, Rodríguez Uranga JJ. Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON). Epilepsy Behav 2020; 102:106655. [PMID: 31812902 DOI: 10.1016/j.yebeh.2019.106655] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Perampanel (PER) has been shown to be effective as an adjunctive therapy for controlling refractory focal-onset seizures (FOS). However, the information as early add-on for the treatment of FOS in the clinical practice is still scarce and must be further assessed. METHODS An observational prospective study was conducted to evaluate the effectiveness of early add-on PER, assessed as 50% responders (seizure frequency reduced by at least 50% during the last 3 months as compared with baseline) rate at 6 and 12 months, in patients with FOS in the routine clinical practice of Spain. RESULTS One hundred and thirteen patients (mean age: 40.3 years, 51.3% male) with FOS received PER as early add-on (1st add-on: 37.2% and 2nd: 62.8%) for a mean exposure of 11 months (mean PER dose: 6.3 mg/day at month 12). At 6 months, 50.4% and 20.4% of the patients were responders and seizure-free (respectively) relative to baseline (3 months prior to PER initiation), and at 12 months, 68.1% and 26.5% of the patients were responders and seizure-free (respectively), relative to baseline (3 months prior to PER initiation). The retention rate at 6 and 12 months was 83.2% and 80.5%, respectively. The percentage of seizure-free patients at 12 months was significantly (p = 0.033) higher when PER was added as first vs. second add-on. The number of concomitant antiepileptic drugs (AEDs) was significantly reduced from baseline to 6 and 12 months (p = 0.001). Treatment was simplified in 23.9% of patients at the end of the observation period. Drug-related adverse events (AEs), most mild or moderate, were reported in 30.1% of patients, with irritability (8%) and dizziness (7.1%) as the most frequent ones. CONCLUSIONS This is the first observational, prospective study to evaluate efficacy and safety of early adjunctive treatment with PER in patients with focal epilepsy at 12 months. Perampanel demonstrated a good efficacy and safety profile when used at a median dose of 6 mg/day, regardless of the combination with other AEDs. Adverse events were mild or moderate, with dizziness being the most frequent one.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - F Vázquez
- Hospital de Torrecárdenas, Almería, Spain
| | | | | | - N Peláez
- Hospital Reina Sofía, Córdoba, Spain
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12
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Perampanel for the treatment of epilepsy; Longitudinal actuarial analysis and dose responses based on monthly outcomes. Seizure 2019; 69:125-132. [DOI: 10.1016/j.seizure.2019.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/10/2019] [Accepted: 04/13/2019] [Indexed: 12/22/2022] Open
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Perampanel-induced weight gain depends on level of intellectual disability and its serum concentration. Epilepsy Res 2019; 152:1-6. [PMID: 30852339 DOI: 10.1016/j.eplepsyres.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/28/2019] [Accepted: 02/24/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Body weight (BW) gain may be induced by perampanel (PER) administration, similar to the well-known adverse effects of valproic acid and gabapentin. Intellectual disability (ID) and serum PER concentration may be risk factors of BW gain. PURPOSE This study investigated how ID and serum PER concentration are associated with PER-induced BW gain. METHODS Subjects were 76 patients with epilepsy (41 men, aged 16-70 years). All patients were divided by intelligence quotient (IQ) into no ID (IQ ≥ 70, n = 24), mild to moderate ID (70 > IQ ≥35, n = 31), and severe to profound ID (IQ < 35, n = 21) groups. BW was measured before and 2, 4, 6, and 12 months after initiation of PER treatment, and serum PER concentration at 12 months. RESULTS BW gains in the mild to moderate ID group at 4, 6, and 12 months were significantly (p < 0.05) higher than in the no ID and in the severe to profound ID groups. At 12 months, BW gain was associated with serum PER concentrations in the no ID (p = 0.034) and the mild to moderate ID (p = 0.001) groups but not in the severe to profound ID group. Multiple linear regression analysis found BW gain at 12 months was positively correlated with the mild to moderate ID group (β = 0.373, p = 0.002) and serum PER concentration (β = 0.241, p = 0.047). CONCLUSIONS The mild to moderate ID group gained more BW than the no ID group, suggesting that PER-induced food intake was greater due to weaker behavioral control in the mild to moderate ID group. The present study suggests a linear correlation between serum PER concentration and BW change.
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Marvanova M. Perampanel-induced, new-onset food aversion in a 29-year-old female with medically refractory frontal lobe epilepsy. Ment Health Clin 2019; 9:100-104. [PMID: 30842918 PMCID: PMC6398359 DOI: 10.9740/mhc.2019.03.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perampanel is a selective, noncompetitive amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid glutamate receptor antagonist indicated for management of partial-onset and primary generalized seizures in epilepsy patients aged ≥12 years. PATIENT HISTORY A 29-year-old, white female with significant history of medically refractory frontal lobe epilepsy, status post right frontal and temporal resections, was initiated on perampanel as an add-on therapy to phenytoin extended-release (330 mg/d) and clonazepam (2.5 mg/d). She previously failed several antiepileptic drugs because of inefficacy and/or intolerance. Perampanel was initiated at 2 mg/d and the dose was increased by 2 mg/d increments every 2 to 3 weeks. Following the first dose, nausea and drowsiness were reported but resolved the following day. Three days after titration to 6 mg/d, the patient developed complete food aversion and became more irritable and anxious while no seizure frequency improvement was noted. No change of sense of taste was reported. After reduction to 4 mg/d, adverse effects improved but did not completely resolve until 2 months following perampanel discontinuation. REVIEW OF LITERATURE A PubMed search revealed no published literature or case reports of perampanel-induced food aversion or anorexia in a presence or absence of phenytoin and clonazepam. CONCLUSION In this report, a temporal relationship was observed between perampanel dose-increase and the development of food aversion. Return to baseline appetite and eating habits following perampanel discontinuation strongly suggest perampanel involvement. At this time, the exact mechanism(s) behind food aversion associated with perampanel is/are unknown.
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15
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Liguori C, Turner K, Izzi F, Assogna M, Canevini MP, Mercuri NB, Placidi F. Preliminary evidence about irritability in patients with epilepsy treated by perampanel as first add-on therapy compared to levetiracetam and valproic acid. CNS Neurosci Ther 2019; 25:632-637. [PMID: 30675751 PMCID: PMC6488879 DOI: 10.1111/cns.13098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/16/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022] Open
Abstract
Aims Irritability has been described as a frequent adverse event in patients affected by epilepsy and treated with perampanel (PER), levetiracetam (LEV), and less frequently with valproic acid (VPA). 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 I‐EPI. Moreover, we compared the effectiveness and I‐EPI scores obtained at 12‐month follow‐up visits in patients treated by PER, LEV, or VPA in order to measure irritability as a consequence of these treatments. Methods We collected data from 17 patients treated by PER, 16 patients treated by LEV, and 16 patients under VPA treatment followed for 12 months. Results We did not document significant changes of I‐EPI questionnaire between baseline and follow‐up in the PER group. As concerning the comparison of I‐EPI among PER, LEV, and VPA groups, we documented lower global scores in PER than both LEV (P < 0.05) and VPA (P < 0.05) groups. Moreover, patients under PER treatment showed lower scores than LEV and VPA (P < 0.05) in I‐EPI items measuring the gentle personality, anxiety of having epileptic seizures in front of others, and irritability in thinking that they can have an epileptic seizure. Conclusions This retrospective study described a stable and possibly lower degree of irritability in patients starting PER than LEV and VPA treatments, although we documented the comparable effectiveness of PER, LEV, and VPA as first add‐on treatments in patients affected by uncontrolled epileptic seizures. However, the small sample of patients included in this study and the absence of I‐EPI scores obtained at baseline visits in LEV and VPA groups require further investigations to confirm this preliminary evidence.
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Affiliation(s)
- Claudio Liguori
- Epilepsy Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Francesca Izzi
- Epilepsy Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Martina Assogna
- Epilepsy Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Nicola B Mercuri
- Epilepsy Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Fabio Placidi
- Epilepsy Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Perampanel chronic treatment does not induce tolerance and decreases tolerance to clobazam in genetically epilepsy prone rats. Epilepsy Res 2018; 146:94-102. [DOI: 10.1016/j.eplepsyres.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/08/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
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17
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Lin KL, Lin JJ, Chou ML, Hung PC, Hsieh MY, Chou IJ, Lim SN, Wu T, Wang HS. Efficacy and tolerability of perampanel in children and adolescents with pharmacoresistant epilepsy: The first real-world evaluation in Asian pediatric neurology clinics. Epilepsy Behav 2018; 85:188-194. [PMID: 30032806 DOI: 10.1016/j.yebeh.2018.06.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/09/2018] [Accepted: 06/17/2018] [Indexed: 12/25/2022]
Abstract
AIM This study investigated the efficacy and safety of perampanel (PER) adjunctive therapy in pediatric patients with epilepsy whose seizures are pharmacoresistant to existing antiepileptic drugs. METHODS A clinical retrospective study was conducted from 2016 to 2017 in the pediatric neurology clinic at a tertiary children's hospital. We reviewed the data obtained from 66 children whose seizures were pharmacoresistant to more than two antiepileptic drugs, and could be followed up for a minimum of 3 months after PER adjunctive therapy initiation. The efficacy was estimated by the PER response rate at 3-, 6-, and 12-month follow-up evaluations, and adverse events were also recorded. RESULTS The rate of seizure reduction of >50% was 30.3%, 37.5%, and 34.7% for all seizure types at 3, 6, and 12 months, in which 7.6%, 8.9%, and 14.3% of the patients became seizure-free at these time points, respectively. No significant differences were found between enzyme-inducing and nonenzyme-inducing antiepileptic drugs in combination with PER with regard to the responder rate. Five patients with Dravet syndrome were included in the study. Four of them (80%) exhibited 50% seizure reduction at the last visit, at which point, two patients (40.0%) were seizure-free. The retention rate was 51% at 12 months. Adverse events were documented in 25 patients (35.7%) and led to PER discontinuation in eight patients (12.1%). The most common adverse events comprised irritability, skin rash, dizziness, and somnolence; however, all were transient and successfully managed after PER dose reduction or discontinuation. CONCLUSION The current data support the value of adjunctive PER in child and adolescent patients with pharmacoresistant epilepsy in daily clinical practice. Perampanel was efficacious and generally well-tolerated as an add-on treatment for epilepsy.
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Affiliation(s)
- Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Liang Chou
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Meng-Ying Hsieh
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Jun Chou
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Villanueva V, Montoya J, Castillo A, Mauri-Llerda JÁ, Giner P, López-González FJ, Piera A, Villanueva-Hernández P, Bertol V, Garcia-Escrivá A, Garcia-Peñas JJ, Garamendi I, Esteve-Belloch P, Baiges-Octavio JJ, Miró J, Falip M, Garcés M, Gómez A, Gil-López FJ, Carreño M, Rodriguez-Uranga JJ, Campos D, Bonet M, Querol R, Molins A, Tortosa D, Salas-Puig J. Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study. Epilepsia 2018; 59:1740-1752. [PMID: 30062784 DOI: 10.1111/epi.14522] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the effectiveness and tolerability of perampanel across different seizure types in routine clinical care of patients with idiopathic generalized epilepsy (IGE). METHODS This multicenter, retrospective, 1-year observational study collected data from patient records at 21 specialist epilepsy units in Spain. All patients who were aged ≥12 years, prescribed perampanel before December 2016, and had a confirmed diagnosis of IGE were included. RESULTS The population comprised 149 patients with IGE (60 with juvenile myoclonic epilepsy, 51 generalized tonic-clonic seizures [GTCS] only, 21 juvenile absence epilepsy, 10 childhood absence epilepsy, 6 adulthood absence epilepsy, and one Jeavons syndrome). Mean age was 36 years. The retention rate at 12 months was 83% (124/149), and 4 mg was the most common dose. At 12 months, the seizure-free rate was 59% for all seizures (88/149); 63% for GTCS (72/115), 65% for myoclonic seizures (31/48), and 51% for absence seizures (24/47). Seizure frequency was reduced significantly at 12 months relative to baseline for GTCS (78%), myoclonic (65%), and absence seizures (48%). Increase from baseline seizure frequency was seen in 5.2% of patients with GTCS seizures, 6.3% with myoclonic, and 4.3% with absence seizures. Perampanel was effective regardless of epilepsy syndrome, concomitant antiepileptic drugs (AEDs), and prior AEDs, but retention and seizure freedom were significantly higher when used as early add-on (after ≤2 prior AEDs) than late (≥3 prior AEDs). Adverse events were reported in 50% of patients over 12 months, mostly mild or moderate, and irritability (23%), somnolence (15%), and dizziness (14%) were most frequent. SIGNIFICANCE In routine clinical care of patients with IGE, perampanel improved seizure outcomes for GTCS, myoclonic seizures, and absence seizures, with few discontinuations due to adverse events. This is the first real-world evidence with perampanel across different seizure types in IGE.
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Affiliation(s)
| | - Javier Montoya
- Lluis Alcanyis Hospital, Xátiva, Spain.,General University Hospital Valencia, Valencia, Spain
| | | | | | - Pau Giner
- University Hospital Dr Peset, Valencia, Spain
| | | | - Anna Piera
- University Hospital Clinic Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | - Júlia Miró
- University Hospital Bellvitge, Barcelona, Spain
| | - Mercè Falip
- University Hospital Bellvitge, Barcelona, Spain
| | | | - Asier Gómez
- University Hospital and Polytechnic La Fe, Valencia, Spain
| | | | | | | | | | | | - Rosa Querol
- University Complex Infanta Cristina, Badajoz, Spain
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Rohracher A, Zimmermann G, Villanueva V, Garamendi I, Sander JW, Wehner T, Shankar R, Ben-Menachem E, Brodie MJ, Pensel MC, Di Gennaro G, Maurousset A, Strzelczyk A, Rheims S, Rácz A, Menzler K, Bertol-Alegre V, García-Morales I, López-González FJ, Toledo M, Carpenter KJ, Trinka E. Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data. Epilepsia 2018; 59:1727-1739. [DOI: 10.1111/epi.14520] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/02/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Alexandra Rohracher
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
| | - Georg Zimmermann
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Department of Mathematics; Paris Lodron University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
| | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
| | - Tim Wehner
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Ruhr-Epileptology; Department of Neurology; Knappschaftskrankenhaus Bochum; Bochum Germany
| | | | | | | | - Max C. Pensel
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | | | - Aude Maurousset
- University Hospital Bretonneau and INSERM U 930; Tours France
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main; Goethe University; Frankfurt Germany
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon and University of Lyon; Lyon France
| | - Attila Rácz
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | - Katja Menzler
- Epilepsy Center Hessen; University Hospital Marburg; Marburg Germany
| | | | | | | | | | | | - Eugen Trinka
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
- Institute of Public Health; Medical Decision Making and HTA; Private University for Health Sciences Medical Informatics and Technology; Hall in Tyrol Austria
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Potschka H, Trinka E. Perampanel: Does it have broad-spectrum potential? Epilepsia 2018; 60 Suppl 1:22-36. [PMID: 29953584 DOI: 10.1111/epi.14456] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 12/26/2022]
Abstract
This article reviews the profile of perampanel, a novel noncompetitive α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) receptor antagonist, and its role as a potential broad-spectrum antiepileptic drug in the treatment of epilepsy. For this narrative review, data were collected using specified search criteria. Articles reporting the evidence for perampanel's efficacy from preclinical models, phase 3 clinical studies, observational studies, and descriptive evidence were included. AMPA receptors play a key role in mediating the action of glutamate at the excitatory synapse. Preclinical research showed the AMPA receptor blockade to constitute a promising target for antiepileptic drug therapy. In animal models, perampanel proved to be protective against seizures and reduce seizure severity and duration. Four phase-3 randomized controlled trials (3 in patients with focal seizures and one in primary generalized tonic-clonic seizures in idiopathic generalized epilepsy) have been completed. In focal (partial) onset seizures, perampanel (4, 8, and 12 mg) significantly reduced seizure frequency per 28 days (23.3%-28.8% vs 12.8%; P < .01) and responder rates (≥50% reduction in seizures) (28.5%-35.3% vs 19.3%; P < .05) compared with placebo. In primary generalized tonic-clonic seizures, perampanel 8 mg resulted in greater reduction in seizure frequency per 28 days (-76.5% vs -38.4%; P < .0001) and responder rate (64.2% vs 39.5%; P = .0019) than placebo. The efficacy, safety, and tolerability of perampanel have been reproduced in real-world clinical practice, and the agent has been shown to be effective in other epilepsy syndromes. Perampanel is a potentially broad-spectrum antiepileptic drug with a novel mechanism of action that may be a useful addition for patients with epilepsy with various seizure types. The availability of novel antiepileptic drugs for epilepsy treatment enables more individualized treatment for these patients.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, University Hospital Paracelsus Medical University, Salzburg, Austria.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, UMIT, Hall in Tyrol, Austria
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Tsai JJ, Wu T, Leung H, Desudchit T, Tiamkao S, Lim KS, Dash A. Perampanel, an AMPA receptor antagonist: From clinical research to practice in clinical settings. Acta Neurol Scand 2018; 137:378-391. [PMID: 29214650 DOI: 10.1111/ane.12879] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
Abstract
Epileptic seizures are refractory to treatment in approximately one-third of patients despite the recent introduction of many newer antiepileptic drugs (AEDs). Development of novel AEDs therefore remains a high priority. Perampanel is a first-in-class non-competitive selective AMPA receptor antagonist with a unique mechanism of action. Clinical efficacy and safety of perampanel as adjunctive treatment for focal seizures with/without secondary generalization (±SG) and primary generalized tonic-clonic (PGTC) seizures have been established in five phase 3 randomized controlled trials (RCTs), and a long-term extension study, and perampanel is approved as monotherapy for focal seizures ±SG in the USA. In patients with focal seizures ±SG, add-on perampanel resulted in median percent reduction in seizure frequency 23.3%-34.5% and ≥50% responder rate 28.5%-37.6%; in PGTC seizures, these results were 76.5% and 64.2%, respectively. Efficacy among adolescents (reduction in seizure frequency 34.8%-35.6%; ≥50% responder rate 40.9%-45.0%) and elderly people (reduction in seizure frequency 12.5%-16.9%; ≥50% responder rate 22.2%-42.9%) is similar to those in adults, and results remain comparable between Asian (reduction in seizure frequency 17.3%-38.0%) and global populations. Perampanel has been extensively studied in real-world clinical practice, with similar efficacy and safety results to the RCTs (≥50% responder rate 12.8%-75.0%; adverse events of somnolence/sedation, dizziness, ataxia, and behavioral changes). Real-world observational studies suggest that perampanel tolerability can be improved by slow titration (2 mg every 2-4 weeks), and bedtime administration can mitigate somnolence and dizziness. Counseling about the potential for behavioral changes and close monitoring are recommended.
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Affiliation(s)
- J.-J. Tsai
- Department of Neurology; National Cheng Kung University Hospital and School of Medicine; National Cheng Kung University; Tainan Taiwan
| | - T. Wu
- Department of Neurology; Chang Gung Memorial Hospital; Chang Gung University; Taoyuan City Taiwan
| | - H. Leung
- Department of Medicine and Therapeutics; Faculty of Medicine; Prince of Wales Hospital; Hong Kong Hong Kong
| | - T. Desudchit
- Department of Paediatrics; King Chulalongkorn Memorial Hospital; Bangkok Thailand
| | - S. Tiamkao
- Integrated Epilepsy Research Group; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - K.-S. Lim
- Division of Neurology; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - A. Dash
- Eisai Singapore Pte. Ltd.; Singapore
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Krauss GL, Perucca E, Kwan P, Ben-Menachem E, Wang XF, Shih JJ, Patten A, Yang H, Williams B, Laurenza A. Final safety, tolerability, and seizure outcomes in patients with focal epilepsy treated with adjunctive perampanel for up to 4 years in an open-label extension of phase III randomized trials: Study 307. Epilepsia 2018; 59:866-876. [DOI: 10.1111/epi.14044] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Emilio Perucca
- IRCCS Mondino Foundation; Pavia Italy
- Department of Internal Medicine and Therapeutics; University of Pavia; Pavia Italy
| | - Patrick Kwan
- Royal Melbourne Hospital; University of Melbourne; Parkville Vic. Australia
- Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong China
| | | | - Xue-Feng Wang
- Chongqing Key Laboratory of Neurology; First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Jerry J. Shih
- Department of Neurosciences; UCSD School of Medicine; La Jolla CA USA
| | - Anna Patten
- Department of Biostatistics; Eisai Ltd.; Hatfield UK
| | - Haichen Yang
- Former Employee of Eisai Inc.; Woodcliff Lake NJ USA
| | - Betsy Williams
- Eisai Neurology Business Group; Eisai Inc.; Woodcliff Lake NJ USA
| | - Antonio Laurenza
- Eisai Neurology Business Group; Eisai Inc.; Woodcliff Lake NJ USA
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Liguori C, Izzi F, Manfredi N, D'Elia A, Mari L, Mercuri NB, Fabio P. Efficacy and tolerability of perampanel and levetiracetam as first add-on therapy in patients with epilepsy: A retrospective single center study. Epilepsy Behav 2018; 80:173-176. [PMID: 29414548 DOI: 10.1016/j.yebeh.2018.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
Perampanel (PER) is a third generation antiepileptic drug (AED), recently approved as add-on therapy in both focal and generalized seizures. Levetiracetam (LEV) is a second generation AED, widely used in patients with epilepsy because of its favorable safety and efficacy profiles. Perampanel and LEV treatments have been associated with the occurrence of similar adverse events (AEs) (sleepiness, irritability, depression, anxiety, aggressiveness). The aim of the present retrospective single center study was to verify the efficacy and tolerability of PER and LEV used as first add-on therapy in patients with epilepsy affected by secondarily generalized seizures. We collected data from 15 patients treated with PER and 26 patients treated with LEV and followed at our site with follow-up visits at 3, 6, and 12months. This retrospective study documented the comparable efficacy of PER and LEV as first add-on treatments in patients affected by uncontrolled secondarily generalized seizures. However, more patients withdrawn LEV because of AEs compared with PER at the 3- and 12-month follow-up visits. The better tolerability of PER observed in this study could be related to the low therapeutic dose of PER prescribed when it is used as first adjunctive treatment for better controlling secondarily generalized seizures.
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Affiliation(s)
- Claudio Liguori
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Francesca Izzi
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Natalia Manfredi
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessio D'Elia
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luisa Mari
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Placidi Fabio
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Chiang HI, Lim SN, Hsieh HY, Cheng MY, Chang CW, Johnny Tseng WE, Li HT, Lin CY, Wu T. Preliminary Asian experience of using perampanel in clinical practice. Biomed J 2018; 40:347-354. [PMID: 29433838 PMCID: PMC6138609 DOI: 10.1016/j.bj.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background To analyze the efficacy and safety of perampanel over a 3-month period in a sample of Asian people with epilepsy. Methods The efficacy and safety of perampanel as an adjunctive therapy for patients with epilepsy were retrospectively reviewed and analyzed. Patients were categorized according to seizure type, concomitant antiepileptic drug usage, and perampanel dosage. Results A total of 210 patients were included in the study and 131 patients completed 3 months of perampanel treatment. The average dosage of perampanel was 5.31 mg/day, and the 50% responder rate (≥50% seizure frequency reduction) in all patients was 45.8%, with a 27.5% seizure-free rate. For focal seizures, focal to bilateral tonic-clonic seizures, and primary generalized seizures, the 50% responder rates were respectively 29.4%, 49.5%, and 36.4%. In total, 39.5% of patients experienced adverse events within 3 months of observation period, and the rate of drug withdrawal due to adverse events was 8.6%. Dizziness, ataxia, irritability/aggression were the most common adverse events. Conclusions The efficacy and safety of perampanel in a real-world setting with Asian patients is comparable to that in clinical trials that have included fewer Asian patients.
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Affiliation(s)
- Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Tao Li
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chin-Yin Lin
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.
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25
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Chen B, Choi H, Hirsch LJ, Katz A, Legge A, Buchsbaum R, Detyniecki K. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy. Epilepsy Behav 2017; 76:24-31. [PMID: 28931473 DOI: 10.1016/j.yebeh.2017.08.039] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/26/2017] [Accepted: 08/27/2017] [Indexed: 11/08/2022]
Abstract
PURPOSE Psychiatric and behavioral side effects (PBSEs) are common, undesirable effects associated with antiepileptic drug (AED) use. The objective of the study was to compare the PBSE profiles of older and newer AEDs in a large specialty practice-based sample of patients diagnosed with epilepsy. METHODS As part of the Columbia and Yale AED Database Project, we reviewed patient records including demographics, medical history, AED use, and side effects for 4085 adult patients (age: 18 years) newly started on an AED regimen. Psychiatric and behavioral side effects were determined by patient or physician report in the medical record, which included depressive mood, psychosis, anxiety, suicidal thoughts, irritability, aggression, and tantrum. Significant non-AED predictors of PBSE rate were first determined from 83 variables using logistic regression. Predictors were then controlled for in the comparison analysis of the rate of PBSEs and intolerable PBSEs (PBSEs that led to dosage reduction or discontinuation) between 18 AEDs. RESULTS Psychiatric and behavioral side effects occurred in 17.2% of patients and led to intolerability in 13.8% of patients. History of psychiatric condition(s), secondary generalized seizures, absence seizures, and intractable epilepsy were associated with increased incidence of PBSE. Levetiracetam (LEV) had the greatest PBSE rate (22.1%). This was statistically significant when compared with the aggregate of the other AEDs (P<0.001, OR=6.87). Levetiracetam was also significantly (P<0.001) associated with higher intolerability rate (17.7%), dose decreased rate (9.4%), and complete cessation rate (8.3%), when compared with the aggregate of the other AEDs. Zonisamide (ZNS) was also significantly associated with a higher rate of PBSE (9.7%) and IPBSE (7.9%, all P<0.001). On the other hand, carbamazepine (CBZ), clobazam (CLB), gabapentin (GBP), lamotrigine (LTG), oxcarbazepine (OXC), phenytoin (PHT), and valproate (VPA) were significantly associated with a decreased PBSE rates (P<0.001). Carbamazepine, GBP, LTG, PHT, and VPA were also associated with lower IPBSE rates when compared individually with the aggregate of other AEDs. All other AEDs were found to have intermediate rates that were not either increased or decreased compared with other AEDs. When each AED was compared to LTG, only CBZ had a significantly lower PBSE rate. The main limitations of this study were that the study design was retrospective and not blinded, and the AEDs were not randomly assigned to patients. CONCLUSIONS Psychiatric and behavioral side effects occur more frequently in patients taking LEV and ZNS than any other AED and led to higher rates of intolerability. Lower PBSE rates were seen in patients taking CBZ, CLB, GBP, LTG, OXC, PHT, and VPA. Our findings may help facilitate the AED selection process.
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Affiliation(s)
- Baibing Chen
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, USA; William Beaumont School of Medicine, Oakland University, Rochester, MI, USA.
| | - Hyunmi Choi
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, USA
| | - Austen Katz
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, USA
| | - Alexander Legge
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, USA
| | - Richard Buchsbaum
- Comprehensive Epilepsy Center, Dept. of Neurology, Columbia University, New York, NY, USA
| | - Kamil Detyniecki
- Comprehensive Epilepsy Center, Dept. of Neurology, Yale University, New Haven, CT, USA
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Wehner T, Mannan S, Turaga S, Vallabhaneni K, Yip HM, Wiggans C, Shankar R, Duncan JS, Sander JW. Retention of perampanel in adults with pharmacoresistant epilepsy at a single tertiary care center. Epilepsy Behav 2017. [PMID: 28624720 DOI: 10.1016/j.yebeh.2017.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Observational data on antiepileptic drugs (AEDs) inform about their use in clinical practice. We describe our clinical experience with perampanel (PER) in a large UK tertiary epilepsy center. METHODS Adults initiated on PER between October 2012 and March 2015 were followed until they discontinued PER or 10 September 2016. Data on epilepsy syndrome, duration, seizure types, concomitant and previous AED use, PER dosing, efficacy and side effects were recorded. Efficacy was categorized as temporary or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefit (e.g. No convulsions or daytime seizures). These categories were mutually exclusive except for people with temporary seizure freedom. RESULTS 391 received a PER prescription, five of whom never took it. No follow-up data were available for ten. 83% had focal epilepsy. People were prescribed PER in addition to 1-7 (Interquartile range [IQR] 2, 2, 3) AEDs and had previously used up to 18 (IQR 5, 7, 10) AEDs. Total exposure was 639patient/years. Retention rates were 60.4% at one year, 48.3% at two years, and 42.7% at three years. 19 (5%) people reported seizure free periods lasting at least six months. A ≥50% reduction in seizures lasting at least six months was reported by 76 people (20%), and marked improvement for ≥6months was seen in 52 (14%). Five (1%) were taken off other AEDs and continued on PER monotherapy for 4-27months. Seizures were aggravated in 57 (15%). Somatic side effects were reported by 197 (52%), mostly CNS. Mood changes, irritability or challenging behavior were reported by 137 (36%). PER was discontinued by 211 (56%) due to adverse effects (39%), inefficacy (26%), or both (35%). No idiosyncratic adverse events were seen. CONCLUSION PER resulted in some benefit in 40% of those exposed. Adverse effects on mental health and on balance were common and should be discussed with people before initiating PER.
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Affiliation(s)
- Tim Wehner
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Shahidul Mannan
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Sanchit Turaga
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Kirtana Vallabhaneni
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Hao Meng Yip
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Carys Wiggans
- Cornwall Partnership NHS Foundation Trust, Adult Developmental Neuropsychiatry, Chygovenck, Threemilestone Industrial Estate, Threemilestone, Truro TR4 9LD, UK.
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Adult Developmental Neuropsychiatry, Chygovenck, Threemilestone Industrial Estate, Threemilestone, Truro TR4 9LD, UK.
| | - John S Duncan
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
| | - Josemir W Sander
- NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, The Netherlands.
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27
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Stephen LJ, Wishart A, Brodie MJ. Psychiatric side effects and antiepileptic drugs: Observations from prospective audits. Epilepsy Behav 2017; 71:73-78. [PMID: 28551500 DOI: 10.1016/j.yebeh.2017.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 01/21/2023]
Abstract
Psychiatric comorbidities are common in people with epilepsy. A retrospective study of characteristics associated with withdrawal due to psychiatric side effects was undertaken in patients with treated epilepsy participating in prospective audits with new antiepileptic drugs (AEDs). A total of 1058 treated patients with uncontrolled seizures (942 focal-onset seizures, 116 generalized genetic epilepsies [GGEs]) participated in eight prospective, observational audits from 1996 to 2014. These patients were prescribed adjunctive topiramate (n=170), levetiracetam (n=220), pregabalin (n=135), zonisamide (n=203), lacosamide (n=160), eslicarbazepine acetate (n=52), retigabine (n=64), or perampanel (n=54). Doses were titrated according to efficacy and tolerability to optimize zeizure outcomes and reduce side effects. Psychiatric comorbidities were recorded prior to and after the addition of each AED. At baseline, patients with focal-onset seizures (189 of 942; 20.1%) were statistically more likely to have psychiatric diagnoses compared to patients with GGEs (14 of 116, 12.1%; p=0.039). Following adjunctive AED treatment, neuropsychiatric adverse effects led to AED withdrawal in 1.9-16.7% of patients. Patients with a pre-treatment psychiatric history (22 of 209; 10.5%) were statistically more likely to discontinue their new AED due to psychiatric issues compared to patients with no previous psychiatric diagnosis (50 of 849; 5.9%; p=0.017). Patients receiving sodium channel blocking AEDs (4 of 212, 1.9%) were statistically less likely to develop intolerable psychiatric problems, compared to those on AEDs possessing other mechanisms of action (68 of 846, 8.0%; p=0.012). Depression was the commonest problem, leading to discontinuation of AEDs in 2.8% (n=30) patients. Aggression was statistically more common in men (11 of 527, 2.1%) compared to women (1 of 531, 0.2%; p=0.004). Patients with learning disability (12 of 122, 9.8%; p=0.0015) were statistically less likely to have psychiatric issues prior to adjunctive AED treatment compared to other patients (208 of 936, 22.2%), but there were no statistically significant differences once the new AEDs were added (8 of 122 patients with learning disability, 6.6%; 64 of 936 other patients, 6.8%). Awareness of these issues may assist clinicians in avoiding, identifying and treating psychiatric comorbidities in people with epilepsy.
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Affiliation(s)
- Linda J Stephen
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK.
| | - Abbie Wishart
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK
| | - Martin J Brodie
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK
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28
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Tremblay G, Barghout V, Patel V, Tsong W, Wang Z. Budget impact of perampanel as adjunctive treatment of uncontrolled partial-onset and primary generalized tonic-clonic seizures in the United States. Epilepsy Behav 2017; 68:196-202. [PMID: 28236697 DOI: 10.1016/j.yebeh.2016.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the budget impact (BI) of adopting perampanel for adjunctive treatment of partial-onset seizures (POS), with or without secondarily generalized seizures, and the adjunctive treatment of primary generalized tonic-clonic seizures (PGTCS) in patients 12years or older in the United States. METHODS A BI model was developed to estimate the potential BI of adopting adjunctive perampanel from a US payer (direct costs only) and societal (direct and indirect costs) perspective over a 5-year period. Efficacy data for perampanel and antiepileptic drug (AED) maintenance therapy were obtained from perampanel phase III clinical trials. Drug, direct medical (healthcare provider, emergency room, and hospitalizations), and indirect (productivity loss) costs were obtained from appropriate sources (e.g., AnalySource® Online [wholesale acquisition costs], 2013 Optum Insight Clinformatics Database [market share percentages, direct medical costs per unit], and 2011-2013 National Health and Wellness Survey [NHWS; healthcare resource utilization, overall work impairment, and baseline distribution of patients across the 4 health states]). Mapping of seizure frequency to medical resource utilization and work impairment was obtained from Kantar Health's NHWS. RESULTS In a hypothetical health plan of 1 million members, 660 (0.066%) members ≥12years old had uncontrolled POS (395 [59.8%]) or PGTCS (265 [40.2%]). During the first 5years of adoption of perampanel, absolute BI (including drug, direct medical, and indirect costs) was $852, $2124, $3855, $5318, and $6397, respectively, for a cumulative absolute BI of $18,545. Drug cost was estimated to increase by $13,888, $34,646, $62,863, $86,728, and $104,326, respectively; however, this cost would be mostly offset by decreases in direct medical ($5041, $12,576, $22,818, $31,481, and $37,869, respectively) and indirect ($7995, $19,946, $36,190, $49,929, and $60,060, respectively) costs. Total per-member-per-month cost (drug and direct medical costs) was estimated to increase by $0.0007, $0.0018, $0.0033, $0.0046, and $0.0055 from years 1 to 5. CONCLUSIONS Based on results of this BI model, increased cost of adopting perampanel in a health plan of 1 million members would be minimal for payers, and societal costs would be close to neutral.
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Affiliation(s)
- Gabriel Tremblay
- Geneconomics Inc., 1372 rue du crepuscule, Levis, QC G7A 4K3, Canada.
| | | | - Vardhaman Patel
- Pharmerit North America LLC, 4350 East-West Highway, Bethesda, MD 20814, USA.
| | - Wan Tsong
- Eisai Inc., 155 Tice Boulevard, Woodcliff Lake, Woodcliff Lake, NJ 07677, USA.
| | - Zhixiao Wang
- Eisai Inc., 155 Tice Boulevard, Woodcliff Lake, Woodcliff Lake, NJ 07677, USA.
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29
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Brodie MJ. Tolerability and Safety of Commonly Used Antiepileptic Drugs in Adolescents and Adults: A Clinician's Overview. CNS Drugs 2017; 31:135-147. [PMID: 28101765 DOI: 10.1007/s40263-016-0406-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper discusses the issues surrounding the tolerability and safety of the commonly used antiepileptic drugs (AEDs) in adolescents and adults. The content includes dose-related adverse effects, idiosyncratic reactions, behavioural and psychiatric comorbidities, chronic problems, enzyme induction and teratogenesis. Twenty-one AEDs are discussed in chronological order of their introduction into the UK, starting with phenobarbital and ending with brivaracetam. Wherever possible, advice is given on anticipating, recognising and managing these issues and thereby improving the lives of people with epilepsy, most of whom will need to take one or more of these agents for life. Avoidance of side effects will increase the possibility of achieving and maintaining long-term seizure freedom. Alternatively, adverse events from AEDs will substantially reduce quality of life and often result in higher healthcare costs.
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Affiliation(s)
- Martin J Brodie
- Epilepsy Unit, West Glasgow ACH-Yorkhill, Dalnair Street, Glasgow, G3 8SJ, Scotland, UK.
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30
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Huber B, Schmid G. A two-year retrospective evaluation of perampanel in patients with highly drug-resistant epilepsy and cognitive impairment. Epilepsy Behav 2017; 66:74-79. [PMID: 28038390 DOI: 10.1016/j.yebeh.2016.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE The objective of this work was to review systematically the efficacy and tolerability of perampanel (PER) in residential patients of an epilepsy center. METHOD We adopted an industry-independent noninterventional retrospective evaluation on the basis of the paper and electronic records complemented by personal information on the part of the treating neurologists. All patients (N=26, 15 females, mean age: 30, range 21-55years) started on PER from its introduction to the market in September 2012 until December 15th 2013 were included. Evaluation was carried out after 6, 12, and 24months of PER treatment. Changes in seizure frequency were calculated as the number of seizures during three months on PER compared to a three-month baseline period. The Clinical Global Impression Scale served as an instrument to record changes in seizure intensity beyond numerical values. Adverse effects were documented by means of the Liverpool Adverse Events Profile. RESULTS Most patients had structural or metabolic epilepsy, 2 patients suffered from Lennox-Gastaut syndrome, 2 from other symptomatic generalized epilepsy. All patients had grade III drug-resistant epilepsy. All patients had additional cognitive deficits of different degree. The retention rates were 61.5% after 6months, 46.2% after 12months, and 42.3% after 24months. The responder rates were 11.5% after 6months, 23.1% after 12months, and 7.7% after 24months. Partial responders (positive CGI and/or seizure reduction <50%) included, the respective values were 26.9%, 38.5%, and 23.1%. Only 1 patient was seizure free at 12months (but not at 24months). A loss of efficacy in the second year of treatment was suspected but the decrease of the responder rate could also be ascribed to a number of different circumstances. Adverse effects in the psychiatric field like irritability, aggression, increased sensitivity, and suicidal ideation/behavior occurred in 50% of the patients. They were the main reason to discontinue PER. CONCLUSIONS After one year of treatment PER showed reasonable efficacy in a particularly difficult-to-treat population. Psychiatric adverse effects forced discontinuation in many cases.
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Affiliation(s)
- Bernd Huber
- VBS Bethel, Ebenezerweg 18, 33617 Bielefeld, Germany.
| | - Gaby Schmid
- VBS Bethel, Ebenezerweg 18, 33617 Bielefeld, Germany.
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