Abstracts

Rationale: At least one-third of people with epilepsy have seizures that are refractory to medication. Thus, there continues to be a need for the introduction of new antiepileptic drugs (AED).  Perampanel 2-[2-oxo-1-phenyl-5-pyridin-2-yl-1, 2 dihydropyridin-3-yl] benzonitrile hydrate) is a non-competitive selective antagonist at the postsynaptic ionotropic alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor. In the United States it is marketed as Fycompa by Eisai and is approved for use as mono-therapy for the treatment of focal onset seizures and as adjunctive therapy for the treatment of generalized from onset tonic-clonic seizures.  We herein report our experience using perampanel in the outpatient setting at our comprehensive epilepsy center. Methods: Retrospective chart review of the patients who were prescribed perampanel between the years 2014 -2017 was performed. The primary outcome was to determine the effectiveness of perampanel, defined as 50% or greater reduction in the total number of seizures. Secondary outcomes included tolerability and adverse-effect profile. Results: A total of 31 patients were prescribed perampanel during our study period. All patients were older than 18 years.  Median duration of follow-up was 2 years. Nineteen patients (62%) had focal epilepsy, 6 (19%) had generalized epilepsy, 6 (19%) had Lennox-Gastaut syndrome (LGS). Eleven patients (35%) stopped taking perampanel within 2 to 6 months after starting it. Eight patients reported mood problems such as anger, irritability and aggression, two patients cited dizziness, two patients cited fatigue, and one stopped it for no clear reason. None of the patients had a pre-existing psychiatric illness. The incidence of adverse-effects did not appear to be dose-dependent, as the majority (45%) of patients experienced them at a dose of 2mg per day. Twenty patients (64.5%) tolerated the medication well. A 50% or greater reduction in the total number of seizures was observed in 13 of these patients (65%), which was our primary outcome measure. Taking the type of epilepsy in to consideration, perampanel was effective in 50% of patients with focal epilepsy; 83% of the patients with LGS and in 100% of the patients with a diagnosis of generalized epilepsy, when the medication was tolerated. None of the patients with LGS stopped perampanel due to adverse-effects.  Conclusions: Perampanel, one of the novel antiepileptic medications, is a safe, effective, and relatively well-tolerated medication. It is FDA-approved for use as monotherapy for treatment of focal onset seizures and as adjunctive therapy for generalized onset tonic-clonic seizures. We observed that when well tolerated, it is more effective for seizure control in patients with LGS and generalized epilepsy compared to focal epilepsy. Careful monitoring of the clinical status and side-effect profile is essential when prescribing perampanel.Significance: Perampanel is an effective and well tolerated AED when used in patients referred to a tertiary epilepsy center. Funding: Not applicable