Adjunctive perampanel therapy for patients with epileptic spasms

• Published in: Pediatric investigation Vol. 64; no. 1; pp. e15364 - n/a
• Main Authors: Matsuura, Ryuki, Hamano, Shin‐ichiro, Ikemoto, Satoru, Daida, Atsuro, Takeda, Rikako, Horiguchi, Ayumi, Hirata, Yuko, Koichihara, Reiko, Kikuchi, Kenjiro
• Format: Journal Article
• Language: English
• Published: Australia John Wiley & Sons, Inc 01.01.2022; Blackwell Publishing Ltd
• Subjects: adverse effects; Age; Anticonvulsants - therapeutic use; Antiepileptic agents; Atrophy; Child; Child, Preschool; Children & youth; Convulsions & seizures; Electroencephalography; Epilepsy; Etiology; Humans; Infant; Intellectual disabilities; Neurology; Nitriles - therapeutic use; Patients; Pediatrics; perampanel; Population studies; Potassium; Remission; Retrospective Studies; Safety; Seizures; Spasm - chemically induced; Spasm - drug therapy; Spasms, Infantile - drug therapy; Treatment Outcome; Vaccines; West syndrome; epilepsy; perampanel; adverse effects; West syndrome; child
• ISSN: 1328-8067; 2096-3726; 1442-200X; 2574-2272
• DOI: 10.1111/ped.15364

Background Perampanel is an antiepileptic drug. Some studies have documented the efficacy of perampanel in epileptic spasms. We aimed to evaluate the efficacy and safety of adjunctive perampanel therapy (PT) in patients with epileptic spasms. Methods We retrospectively surveyed the efficacy and safety of adjunctive PT in 14 patients with epileptic spasms at the Saitama Children's Medical Center between June 2016 and September 2021. Seizure outcomes and safety were evaluated 12 months after commencing PT. Response to perampanel was defined as complete remission of epileptic spasms for more than 3 months. Results The median age at onset of epileptic spasms was 0.4 years (range, 0.1–1.3 years). The etiology was structural in 11 patients, genetic in two, and unknown in one. The median age at the commencement of PT was 3.2 years (1.5–10.3 years). The initial and maintenance doses of perampanel were administered at 0.04 (range, 0.02–0.05) mg/kg/day and 0.12 (range, 0.03–0.24) mg/kg/day, respectively. Five of the 14 patients (35.7%) showed remission of epileptic spasms for more than 3 months at 12 months after PT; these patients had a structural etiology. The median duration between commencement of perampanel and spasm remission was 2 months (range, 1–6 months). No serious adverse effects occurred. Conclusions This is the first case series evaluating adjunctive PT for epileptic spasms. PT is worth investigating to treat epileptic spasms in patients with structural etiologies. As our study population primarily comprised children aged 2 years and older, PT may be useful for epileptic spasms beyond infancy.