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The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
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Perampanel in chronic insomnia.

M J Abenza-Abildúa1, E Suárez-Gisbert2, I J Thuissard-Vasallo3

  • 1Neurology Department, Sleep Medicine Centre, Universitary Hospital Infanta Sofía, Madrid, Spain.

Clinical Neurology and Neurosurgery
|February 21, 2020
PubMed
Summary
This summary is machine-generated.

Perampanel, an antiepileptic drug, significantly improved sleep quality in patients with chronic insomnia when combined with antidepressants or anxiolytics. This study suggests perampanel as a potential treatment for resistant insomnia.

Keywords:
Antiepileptic drugChronic insomniaISI scalePerampanelPittsburgh scaleResistant insomniaSleep scales

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Pharmacology

Background:

  • Insomnia is a prevalent sleep disorder, frequently leading to consultations in sleep units.
  • Perampanel, an antiepileptic, has shown efficacy in sleep structure and restless legs syndrome.

Purpose of the Study:

  • To evaluate the efficacy of perampanel in patients suffering from chronic, treatment-resistant insomnia.
  • To assess the impact of perampanel on sleep quality and duration in this patient group.

Main Methods:

  • An observational retrospective cohort study involving 66 patients with chronic resistant insomnia.
  • 33 patients received perampanel (2-4 mg) combined with antidepressants or anxiolytics for 3 months, compared to 33 non-exposed controls.
  • Sleep quality was measured using the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI).

Main Results:

  • The perampanel group showed significant improvements: 6-point increase in ISI (p=0.02) and 4-point increase in PSQI (p=0.04), with an average gain of 2.5 hours of sleep.
  • The non-exposed group had smaller improvements: 2.2 points in ISI (p=0.06) and 1.6 points in PSQI (p=0.01).
  • Adverse effects included irritability in 3 patients; 12.12% discontinued treatment due to irritability, lack of efficacy, or pregnancy wish.

Conclusions:

  • Combination therapy with perampanel, antidepressants, or anxiolytics significantly enhances sleep quality in chronic resistant insomnia.
  • Perampanel's efficacy may be linked to its glutamatergic antagonistic action.
  • Further placebo-controlled clinical trials are warranted to confirm these findings.