E&B: Efficacy of perampanel adjuvant therapy in children with uncontrolled epilepsy

Perampanel adjuvant therapy for childhood epilepsy is not well studied, and there is a lack of large studies
in China.
The journal Epilepsy & Behavior published a study evaluating the efficacy, safety, and tolerability of Perampanel adjunctive therapy for children and adolescents with epilepsy
.

The study recruited pediatric patients
who attended the Pediatric Epilepsy Clinic of Henan Provincial People's Hospital between May 2020 and December 2021.
All patients received Perampanel as an adjunct therapy 1 time daily
at bedtime.
The initial dose is 1 mg/day or 0.
03~0.
05 mg/kg/d
.
The dose of Perampanel is up-regulated every 2 weeks until the target dose is reached or seizure-free status
is reached.
The target dose is 4~8 mg/day or 0.
1~0.
15 mg/kg/day
.
Seizure frequency
after adjuvant treatment with Perampanel was assessed and recorded.
Effectiveness
was assessed based on changes in seizure frequency relative to baseline during the follow-up period.
Responders were patients
with a 50% reduction in seizures from baseline.
Except for patients without seizures, the responders are 50%~99% responders
.

The results showed that 114 patients were enrolled, and 7 cases (6.
1%)
were lost to follow-up.

At 12 weeks, the response rate and seizure-free rate were 56.
1% (60/107) and 32.
7% (35/107),
respectively.
The response rate increased with the duration of Perampanel administration, reaching 77.
1% (27/35)
at week 48.

At 24 weeks, the response rate was 52.
6% (20/38) in patients with structural abnormalities and 75.
8% (25/33) in patients without structural abnormalities, with no significant difference (P = 0.
052).

In patients with genetic abnormalities, ion channel-related mutations, and SCN1A mutations, the response rates were 54.
6% (12/22), 56.
2% (9/16), and 66.
7% (6/9),
respectively.
There was also no significant difference in response rates between the focal seizure epilepsy, generalized seizure epilepsy, and epilepsy syndrome groups (P = 0.
657).

At week 12, 35 patients used Perampanel as an early add-on (after 2 previous antiepileptic drugs (ASM)) and 72 patients used Perampanel as an advanced add-on (> after 2 previous ASMs).

At 12 and 24 weeks, the response rate was significantly higher in the early addition group than in the late addition group (P = 0.
01 at 12 weeks, P = 0.
004 at 24 weeks).

At 48 weeks, the former also had a higher response rate, with no statistically significant difference (P = 0.
073).

Adverse events were reported in 32 patients (29.
9%), including irritability, dizziness, lethargy, ataxia gait, weight gain, and tinnitus
.

The results confirmed the effectiveness and tolerability of adjuvant therapy with Perampanel in the routine clinical setting of
pediatric epilepsy patients.
Of note, patients who added Perampanel treatment early showed better epilepsy outcomes
than those who added Perampanel treatment late.

Original source:

Li Gao, Lina Shi, et al, Effectiveness and tolerability of adjunctive perampanel in the treatment of pediatric patients with uncontrolled epilepsy: A retrospective, single-center, real-world study, Epilepsy & Behavior, 2022, https://doi.
org/10.
1016/j.
yebeh.
2022.
108961.