The Cognitive and Behavioural Effects of Perampanel in Children with Neurodevelopmental Disorders: A Systematic
Giovanna Scorrano1, Simona Lattanzi2, Vincenzo Salpietro3,4
1Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy.
Insights
Perampanel (PER) in pediatric epilepsy showed no harm to general cognition but improved verbal memory, though attentional power declined. Psychiatric side effects like irritability were noted in adolescents with refractory epilepsy.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Neurodevelopmental comorbidities significantly impact the quality of life in children and adolescents with epilepsy.
- Understanding the cognitive and behavioral effects of antiseizure medications in pediatric populations is crucial.
Purpose of the Study:
- To systematically review the cognitive and behavioral effects of perampanel (PER) in pediatric patients with epilepsy.
- To identify potential risk factors associated with adverse neuropsychiatric outcomes during PER treatment in this age group.
Main Methods:
- Systematic literature search for studies on pediatric epilepsy patients treated with perampanel.
- Inclusion of 18 studies with 3563 participants.
- Assessment of cognitive and behavioral outcomes using standardized neuropsychological scales.
Main Results:
- Perampanel did not negatively affect general cognitive functions or visuospatial skills.
- A slight improvement in verbal memory and a decline in attentional capacity were observed.
- Adolescents with refractory epilepsy on high-dose or rapidly titrated PER, or with pre-existing psychiatric disorders, faced increased risks of anger, aggressiveness, and irritability.
Conclusions:
- Perampanel demonstrates an overall favorable risk-benefit profile in pediatric epilepsy.
- Careful consideration of pharmacodynamics, co-administered medications, and patient history of neuropsychiatric disorders is recommended before initiating PER.
- Further research is needed due to limited data on new antiseizure medications in developing individuals.
Abstract:
In children and adolescents with epilepsy, neurodevelopmental comorbidities can impair the quality of life more than seizures. The aim of this review was to evaluate the cognitive and behavioural effects of perampanel (PER) in the paediatric population. We performed a systematic search of the literature, selecting studies published in English including children and adolescents with epilepsy treated with PER. Cognitive and behavioural outcomes were assessed through validated neuropsychological standardised scales. Eighteen studies involving 3563 paediatric patients were included. Perampanel did not impair general cognitive functions and visuospatial skills, whereas a slight improvement in verbal memory and a decline in attentional power were detected. In adolescents with refractory epilepsies, high doses and/or rapid titration of PER and an underlying psychiatric disorder were risk factors for developing or worsening psychiatric outcomes such as anger, aggressiveness, and irritability. Data on children and adolescents treated with new antiseizure medications are scant, and neuropsychiatric effects are tricky to be detected during developmental age. According to the currently available evidence, PER showed an overall favourable risk-benefit profile. Pharmacodynamics, co-administration of other antiseizure medications, and family and personal history of neuropsychiatric disorders should be considered before PER treatment.
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