Perampanel Add-on Therapy for the Treatment of Children and Adolescents with Partial and Primary Generalized Seizures: A Report from the University Hospital of Innsbruck

 

Background/Purpose: Perampanel (PER) is a selective noncompetitive antagonist of AMPA-glutamate receptors on postsynaptic neurons. PER is used as add-on therapy for the treatment of partial and generalized tonic-clonic seizures in patients older than 12 years of age.

Methods: Twelve patients aged 5 to 18 years (younger than 12 years “off-label” use) were included in this single-center, retrospective study. All patients suffered from refractory epilepsy and were treated with PER from December 2012 to January 2017 at the Department of Pediatrics, University Hospital Innsbruck.

Results: Seven patients were females and five were males. Four patients suffered from partial, seven from generalized epilepsy, and one patient suffered from Lennox-Gastaut syndrome. Five patients took one, Five patients took two, and two patients took three antiepileptic drugs. Seven patients are ongoing treatment, the maximum treatment period is currently 3 years and 9 months. Two patients achieved complete seizure control, two patients showed a seizure reduction of 50%, and in grand-mal seizures were controlled in two patients. In two patients, the seizure pattern remained unchanged, while three patients developed an aggravation of seizures. The most common reversible adverse effects were in six patients with aggressiveness and in five patients with dizziness.

Conclusion: In spite of low number of cases, the reported data show that PER controls seizures significantly in one-third of cases. Adverse effects were observed especially upon reaching the assigned dose and could be limited by PER dosage reduction. Long-term surveillance and further studies with lager case numbers are necessary to confirm our results.