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Young children with multidrug-resistant epilepsy and vagus nerve stimulation responding to perampanel: A case report
1Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Insights
Perampanel (PER) effectively reduced seizures in a young child with multidrug-resistant epilepsy. This antiepileptic drug showed promise as an add-on therapy, though behavioral side effects were noted.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Perampanel (PER) is a selective α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist approved for focal epilepsy in adults and adolescents.
- Limited data exists on PER's efficacy and tolerability in young children with multidrug-resistant epilepsy (MRE).
- This case report details clinical experience with PER in a pediatric patient with MRE.
Observation:
- A 4-year-old boy with idiopathic MRE, refractory to multiple anti-seizure medications and vagus nerve stimulation (VNS), was treated with PER.
- PER administration resulted in a dose-dependent significant reduction in seizure frequency.
- Improved cognitive behavior was observed concurrently with PER treatment.
Findings:
- PER demonstrated efficacy as an add-on therapy in a young child with VNS-refractory, multidrug-resistant epilepsy.
- The treatment was associated with dose-dependent seizure reduction and cognitive improvements.
- Adverse effects, including anger and aggression, were reported during PER therapy.
Implications:
- Perampanel may be a viable treatment option for select pediatric patients with refractory epilepsy.
- Further research is warranted to establish the long-term efficacy and safety profile of PER in young children.
- Understanding and managing potential behavioral side effects is crucial for optimizing PER therapy in pediatric populations.
Background:
Perampanel (PER), a third-generation antiepileptic drug, is a selective and noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist, and has been approved for the treatment of adults and adolescents with focal epilepsy. However, there are only a few studies about the efficacy and tolerability of PER in young children with multidrug-resistant epilepsy. In this case, we aimed to share our clinical experience in this group.
Case Summary:
A 4-year-old boy without perinatal asphyxia and familial history of epilepsy began to have ictal seizures from age 14 mo, with jerky movement of four limbs and head nodding. Abnormal multifocal discharge and background activity were recorded through electroencephalography, and no pathogenic mutation was found in the whole exome sequencing for the patient and his parents. He had received valproate, levetiracetam, topiramate, oxcarbazepine, clonazepam and lacosamide sequentially at different times, but he still had frequent seizures even after vagus nerve stimulation (VNS) implantation. He was diagnosed with idiopathic multidrug-resistant epilepsy. However, his seizure frequency was significantly reduced after PER administration in a dose-dependent manner, and better cognitive behavior was observed. In addition, the adverse reactions of anger and aggression also appeared.
Conclusion:
PER is effective as add-on therapy for young children with multidrug-resistant epilepsy who have previously undergone VNS implantation.
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