Izumoto Shuichi, Miyauchi Masaharu, Tasaki Takayuki, Okuda Takeshi, Nakagawa Nobuhiro, Nakano Naoki, Kato Amami, Fujita Mitsugu
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Anticancer Res. 2018 Jul;38(7):4361-4366. doi: 10.21873/anticanres.12737.
BACKGROUND/AIM: Excessive extracellular glutamate activates AMPA-type glutamate receptors (AMPA receptors) and induces seizures. Antagonistic activation of AMPA receptors inhibits epilepsy and glioma growth in in vitro and in vivo studies. This study was conducted to evaluate the clinical impacts of perampanel (PER), a novel AMPA receptor antagonist, on seizures and tumor progression in glioma patients with uncontrollable epilepsy.
Twelve glioma patients with uncontrollable epilepsy were treated with PER. Seizure response, PER concentration, and tumor volume were assessed.
Obvious seizure control was observed in 10 analyzed patients (100%) and 6 patients (60%) became seizure-free. Median plasma concentrations of PER were 296 ng/ml in those with 4 mg/day PER treatment and 518 ng/ml in those with 8 mg/day PER treatment. High-intensity lesions in fluid-attenuated inversion recovery of magnetic resonance imaging (MRI) were volumetrically assessed to analyze tumor size. Volume reduction was detected within 6 months in correlation with increased plasma levels of PER.
PER treatment was effective in uncontrollable epilepsy with gliomas. MRI images showed the inhibition of tumor growth.
背景/目的：细胞外谷氨酸过量会激活α-氨基-3-羟基-5-甲基-4-异恶唑丙酸型谷氨酸受体（AMPA受体）并诱发癫痫发作。在体外和体内研究中，对AMPA受体的拮抗激活可抑制癫痫和胶质瘤生长。本研究旨在评估新型AMPA受体拮抗剂吡仑帕奈（PER）对癫痫无法控制的胶质瘤患者癫痫发作和肿瘤进展的临床影响。
12例癫痫无法控制的胶质瘤患者接受了PER治疗。评估癫痫发作反应、PER浓度和肿瘤体积。
在10例分析的患者（100%）中观察到明显的癫痫控制，6例患者（60%）癫痫发作停止。每日服用4 mg PER治疗的患者PER血浆浓度中位数为296 ng/ml，每日服用8 mg PER治疗的患者为518 ng/ml。通过磁共振成像（MRI）的液体衰减反转恢复序列中的高强度病变进行体积评估以分析肿瘤大小。在6个月内检测到肿瘤体积缩小，且与PER血浆水平升高相关。
PER治疗对伴有胶质瘤的癫痫无法控制有效。MRI图像显示肿瘤生长受到抑制。
