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Perampanel and childhood absence epilepsy: A real life experience
Francesca Felicia Operto1, Alessandro Orsini2, Gianpiero Sica3
1Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
Insights
Perampanel (PER) effectively controlled absence seizures in children with childhood absence epilepsy as an add-on therapy and in monotherapy, with a favorable tolerability profile. The treatment did not negatively impact cognitive or behavioral functions in children or parental stress.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Pharmacology
Background:
- Childhood absence epilepsy (CAE) requires effective and well-tolerated treatments.
- Perampanel (PER) is an antiseizure medication with a novel mechanism of action.
- Evaluating PER in pediatric populations is crucial for expanding treatment options.
Purpose of the Study:
- To assess the efficacy and tolerability of perampanel (PER) in children with CAE.
- To evaluate PER as both a first add-on therapy and in monotherapy.
- To investigate the impact of PER on neuropsychological functions and behavioral outcomes.
Main Methods:
- A cohort of 20 children (8-10 years) with CAE received PER as add-on therapy.
- Dose titration of PER ranged from 3-8 mg/day.
- Seizure frequency, neuropsychological evaluations, and behavioral/stress questionnaires were assessed.
Main Results:
- 15/20 patients responded to add-on PER, with 9/15 remaining seizure-free on monotherapy.
- 10% of patients experienced mild, transient side effects (irritability, headache, dizziness).
- PER did not adversely affect non-verbal intelligence, executive functions, emotional/behavioral symptoms, or parental stress.
Conclusions:
- Perampanel demonstrates effectiveness and favorable tolerability for absence seizures in pediatric patients.
- PER shows potential as a monotherapy option for childhood absence epilepsy.
- Further controlled studies are warranted to confirm these findings.
Objectives:
The aim of our study was to evaluate the effectiveness and tolerability of perampanel (PER) as first add-on and as second line monotherapy in subjects with childhood absence epilepsy.
Methods:
Our sample consisted of 20 patients with childhood absence epilepsy, aged between 8 and 10, already in therapy with a first antiseizure medication with incomplete seizure control. PER was added as first add-on in a dose ranging from 3 to 8 mg/die with 1- 2 mg/week increments. The patients that were seizure-free were shifted to a PER monotherapy. All patients underwent a standardized neuropsychological evaluation in order to assess non-verbal intelligence and executive functions before adding PER and after 6 months of drug therapy. All parents completed two questionnaires, in order to assess the emotional-behavioral problems and parental stress.
Results:
15/20 patients responded to add-on PER and were seizure-free, in 3/20 patients we observed a reduction of seizure frequency <50%, and in the 2 remaining patients the add-on therapy with PER did not lead to a reduction in seizures frequency from baseline. The patients who were seizure-free were switched to PER monotherapy. 9/15 patients remained seizure-free in monotherapy with PER. In the first month of therapy with PER 2/20 patients (10%) reported mild, transient side effects of irritability, headache and dizziness, which did not lead to discontinuation of therapy. Adjunctive treatment with PER did not negatively affect non-verbal intelligence, executive functions, emotional/behavioral symptoms of children and parental stress levels.
Significance:
Our clinical experience in real life showed that PER appears to be effective in the control of absence seizures in childhood absence epilepsy, with a favorable tolerability profile. PER would seem effective on absence seizures even in monotherapy. Further studies with larger samples, longer follow-up and controlled vs. placebo (or other first choice antiseizure medications) are needed to confirm our data.
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