Usefulness of perampanel as initial monotherapy in children with non-lesional focal epilepsy
Hideaki Kanemura1,2, Yoshihiro Miyasato1, Yutaro Tomi1
1Department of Pediatrics, Toho University Medical Center Sakura Hospital, Sakura, Chiba 285-8741, Japan.
Insights
Perampanel (PER) demonstrated superior efficacy in reducing clinical seizures and epileptiform discharges compared to carbamazepine (CBZ) as initial monotherapy for pediatric focal epilepsies. PER also showed a better safety profile with fewer adverse events.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Non-lesional focal epilepsies in children require effective and safe initial monotherapy.
- Carbamazepine (CBZ) and perampanel (PER) are established antiepileptic drugs.
- Comparative data on their efficacy and safety as first-line treatment in pediatric populations is limited.
Purpose of the Study:
- To compare the efficacy and safety of carbamazepine (CBZ) versus perampanel (PER) as initial monotherapy for non-lesional focal epilepsies in children.
- To assess the impact on clinical seizures and electroencephalographic abnormalities (interictal epileptiform discharges - IEDs).
- To evaluate the safety profiles of both agents.
Main Methods:
- Retrospective review of pediatric epilepsy outpatients treated between 2000-2022.
- Inclusion criteria: initial monotherapy with CBZ or PER and ≥12 months follow-up.
- Efficacy defined by seizure/IED reduction; safety by adverse event (AE) rates.
Main Results:
- Perampanel (PER) showed significantly higher total efficacy rates for both clinical seizures (p=0.0148) and IEDs (p<0.0001) compared to carbamazepine (CBZ).
- PER also demonstrated a significantly higher rate of complete seizure/IED disappearance (p=0.0133).
- Adverse event rates were significantly lower with PER than with CBZ (p=0.023).
Conclusions:
- Perampanel (PER) appears to be a more effective initial monotherapy option than carbamazepine (CBZ) for children with non-lesional focal epilepsies.
- PER offers a favorable efficacy and safety profile in this specific pediatric population.
- Further prospective studies could validate these findings.
Abstract:
This study aimed to compare carbamazepine (CBZ) and perampanel (PER) in terms of the efficacy against clinical seizures and electroencephalographic abnormalities such as interictal epileptiform discharges (IEDs) and safety as initial monotherapy in children with non-lesional focal epilepsies. This retrospective review included participants recruited from among epilepsy outpatients treated at the authors' hospital between January 01, 2000, and December 31, 2019 in the CBZ group and between January 01, 2020, and December 31, 2022 in the PER group. The inclusion criterion in both groups was ≥12 months of follow-up. Responders were identified as participants demonstrating complete disappearance (100 % reduction in seizures or IEDs) or response (>50 % reduction in seizure frequency or IEDs). Safety primary outcome was defined as appearance rate of AEs. The study group comprised 247 participants treated with CBZ and 46 participants treated with PER. Total efficacy rate for clinical seizures was significantly higher with PER than with CBZ (p = 0.0148). Moreover, the rate of complete disappearance was significantly higher with PER than with CBZ (p = 0.0133). Total efficacy rate for IED was again significantly higher with PER than with CBZ (p < 0.0001). The appearance of adverse events was significantly lower with PER than with CBZ (p = 0.023). PER may be useful as initial monotherapy in children with non-lesional focal epilepsies.
Related Concept Videos
01:14Antiepileptic Drugs: Glutamate Antagonists
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
01:08Antiepileptic Drugs: Sodium Channel Blockers
Sodium channel blockers modulate ion channels, particularly voltage-gated sodium channels. They block only sodium ion movement.
Among the most commonly prescribed antiepileptic drugs are...
01:17Antiepileptic Drugs: Calcium Channel Blockers
Calcium channel blockers exert their antiepileptic effects by targeting T-type calcium channels, which are integral to transmitting nerve signals in the central nervous system. These channels allow the passage of calcium ions, which are vital for neuronal communication. By inhibiting T-type calcium channels, calcium channel blockers effectively reduce the release of neurotransmitters and...