Wehner Tim, Mannan Shahidul, Turaga Sanchit, Vallabhaneni Kirtana, Yip Hao Meng, Wiggans Carys, Shankar Rohit, Duncan John S, Sander Josemir W
NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square WC1N 3BG, and Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
Cornwall Partnership NHS Foundation Trust, Adult Developmental Neuropsychiatry, Chygovenck, Threemilestone Industrial Estate, Threemilestone, Truro TR4 9LD, UK.
Epilepsy Behav. 2017 Aug;73:106-110. doi: 10.1016/j.yebeh.2017.04.006. Epub 2017 Jun 16.
Observational data on antiepileptic drugs (AEDs) inform about their use in clinical practice. We describe our clinical experience with perampanel (PER) in a large UK tertiary epilepsy center.
Adults initiated on PER between October 2012 and March 2015 were followed until they discontinued PER or 10 September 2016. Data on epilepsy syndrome, duration, seizure types, concomitant and previous AED use, PER dosing, efficacy and side effects were recorded. Efficacy was categorized as temporary or ongoing (at last follow-up) seizure freedom, ≥50% seizure reduction, or other benefit (e.g. No convulsions or daytime seizures). These categories were mutually exclusive except for people with temporary seizure freedom.
391 received a PER prescription, five of whom never took it. No follow-up data were available for ten. 83% had focal epilepsy. People were prescribed PER in addition to 1-7 (Interquartile range [IQR] 2, 2, 3) AEDs and had previously used up to 18 (IQR 5, 7, 10) AEDs. Total exposure was 639patient/years. Retention rates were 60.4% at one year, 48.3% at two years, and 42.7% at three years. 19 (5%) people reported seizure free periods lasting at least six months. A ≥50% reduction in seizures lasting at least six months was reported by 76 people (20%), and marked improvement for ≥6months was seen in 52 (14%). Five (1%) were taken off other AEDs and continued on PER monotherapy for 4-27months. Seizures were aggravated in 57 (15%). Somatic side effects were reported by 197 (52%), mostly CNS. Mood changes, irritability or challenging behavior were reported by 137 (36%). PER was discontinued by 211 (56%) due to adverse effects (39%), inefficacy (26%), or both (35%). No idiosyncratic adverse events were seen.
PER resulted in some benefit in 40% of those exposed. Adverse effects on mental health and on balance were common and should be discussed with people before initiating PER.
抗癫痫药物（AEDs）的观察性数据反映了它们在临床实践中的使用情况。我们描述了在英国一家大型三级癫痫中心使用吡仑帕奈（PER）的临床经验。
对2012年10月至2015年3月开始使用PER的成年人进行随访，直至他们停用PER或2016年9月10日。记录癫痫综合征、病程、发作类型、同时使用和既往使用的AEDs、PER剂量、疗效和副作用的数据。疗效分为暂时或持续（最后一次随访时）无癫痫发作、癫痫发作减少≥50%或其他益处（如无惊厥或日间癫痫发作）。除了暂时无癫痫发作的人外，这些类别相互排斥。
391人接受了PER处方，其中5人从未服用。10人没有随访数据。83%患有局灶性癫痫。人们在使用1 - 7种（四分位间距[IQR]为2、2、3）AEDs的基础上加用PER，既往曾使用多达18种（IQR为5、7、10）AEDs。总暴露量为639患者/年。1年时的保留率为60.4%，2年时为48.3%，3年时为42.7%。19人（5%）报告无癫痫发作期持续至少6个月。76人（20%）报告癫痫发作减少≥50%且持续至少6个月，52人（14%）在≥6个月时病情有明显改善。5人（1%）停用了其他AEDs，继续使用PER单药治疗4 - 27个月。57人（15%）癫痫发作加重。197人（52%）报告有躯体副作用，主要是中枢神经系统方面的。137人（36%）报告有情绪变化、易怒或攻击性行为。211人（56%）因不良反应（39%）、无效（26%）或两者皆有（35%）而停用PER。未观察到特异质性不良事件。
40%的使用PER的人有一定益处。对心理健康和平衡的不良反应很常见，在开始使用PER前应与患者讨论。
