Behavioural changes in patients with intellectual disability treated with perampanel

Area of Science:

• Neurology
• Epileptology
• Pharmacology

Background:

• Drug-resistant epilepsy is a significant challenge, particularly in patients with intellectual disability (ID).
• Perampanel is an antiepileptic drug with a novel mechanism of action, but its use in patients with ID is not well-established.
• Assessing the tolerability and efficacy of perampanel in this specific population is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate the tolerability and efficacy of perampanel in patients with drug-resistant epilepsy and co-occurring intellectual disability (ID).
• To analyze adverse events and behavioral changes associated with perampanel treatment in this patient group.

Main Methods:

• A retrospective, non-interventional study involving 27 patients with ID and drug-resistant epilepsy.
• Patients received perampanel (4-12 mg daily) after a 3-month baseline observation period.
• Data collected included seizure records, retention rates, Clinical Global Impression scale, and the Aggressive Behaviour Scale (ABS) over 24 months.

Main Results:

• Perampanel was efficacious and well-tolerated in only 5 out of 25 patients.
• Treatment was discontinued in 18 patients due to adverse events, lack of efficacy, or both.
• Behavioral changes, including aggression (observed in 6 patients via ABS), ataxia (6 patients), and sedation (8 patients), were noted in a significant number of patients.

Conclusions:

• Perampanel demonstrated limited efficacy and tolerability in approximately one-fifth of patients with drug-resistant epilepsy and ID.
• A notable proportion of patients experienced challenging behaviors, ataxia, and sedation.
• Further research is needed to fully understand perampanel's tolerability profile in patients with intellectual disability.