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Epilepsy Behav. 2014 Dec;41:193-6. doi: 10.1016/j.yebeh.2014.09.072. Epub 2014 Oct 30.

Clinical experience with perampanel: focus on psychiatric adverse effects.

Author information

1
Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK.
2
Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK; University of Manchester, Manchester, UK.
3
Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK; University of Manchester, Manchester, UK. Electronic address: Rajiv.Mohanraj@srft.nhs.uk.

Abstract

BACKGROUND:

Perampanel (PER) is a novel antiepileptic drug that inhibits the AMPA class of glutamate receptors. It has been available in the UK since September 2012. We undertook a retrospective analysis of efficacy and tolerability of PER in 47 patients with drug-refractory epilepsy attending a regional epilepsy service in the UK.

METHODS:

Demographic and clinical data of patients with refractory epilepsy prescribed PER were collected by review of records. Efficacy, as measured by responder rates (>50% reduction in seizure frequency), retention rates, and adverse effects, was analyzed.

RESULTS:

Of the 47 patients prescribed PER, 39 (87%) had focal epilepsy, four (9%) had idiopathic generalized epilepsy, 3 (6%) had symptomatic generalized epilepsy, and 1 had unclassified epilepsy. Patients were taking a median of 2 AEDs (range: 1-5) when starting on PER. The median dose of PER was 8 mg (range: 2-12 mg). Thirteen (28%) patients were classed as responders, but no patients experienced sustained seizure freedom. Twenty-one (45%) patients had withdrawn from PER during the study period, with 16 (76%) of them withdrawing due to intolerable adverse effects, 4 due to inadequate seizure control, and 1 due to the combination of both. The most frequent adverse effects requiring withdrawal from PER were behavioral reactions including suicidal ideation (n = 2), aggressive behavior (n = 2), and both (n = 1).

CONCLUSION:

In our experience, PER had a retention rate of 55% and a responder rate of 28%. Psychiatric adverse effects, including suicidal ideation, were the most common reasons for withdrawal.

KEYWORDS:

Epilepsy; Perampanel; Suicidality

PMID:
25461214
DOI:
10.1016/j.yebeh.2014.09.072
[Indexed for MEDLINE]

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