Kim Soo Yeon, Kim Woo Joong, Kim Hyuna, Choi Sun Ah, Lim Byung Chan, Chae Jong-Hee, Kim Ki Joong
Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
J Epilepsy Res. 2018 Dec 31;8(2):61-65. doi: 10.14581/jer.18010. eCollection 2018 Dec.
There are only limited studies on perampanel (PER), one of the latest antiepileptic drug. This study aimed to evaluate the long-term efficacy and tolerability of perampanel as an add-on therapy in patients with intractable focal epilepsy.
The medical records of 97 patients (age, 12-30 years) were retrospectively reviewed and analyzed. The patients had been diagnosed with focal epilepsy, treated with PER, and regularly followed up over 12 months.
All patients had uncontrolled seizures despite treatment with two or more antiepileptic drugs. The mean age of seizure onset was 5.2 years (range, 0-17.0). PER was first prescribed at an average age of 15.7 years (range, 12.0-25.3), and mean follow-up duration after PER initiation was 15.9 months (range, 12-20). The responder rate was 41.7%, with over 75% seizure reduction obtained in 11 cases (15.3%), including three seizure-free cases (4.2%). The retention rates at 3, 6, 12, and 18 months of follow-up were 82.5% (80/97), 72.1% (70/97), 60.8% (59/97), and 37.5% (6/16), respectively. Forty-four patients (44/97, 45.4%) discontinued PER, because of treatment-related adverse events in 20 (20.6%) and no efficacy in 24 (24.7%). Treatment-related adverse events were reported by 52 patients (53.6%). The most common adverse event was somnolence or lethargy, reported by 17 patients (17/97, 23%), followed by dizziness (15/97, 20%) and psychological problems such as aggressiveness or irritability (15/97, 20%). Thirty-three patients (33/52, 63.4%) showed their first adverse symptom for 2 or 4 mg/day of PER.
PER would be an effective therapeutic option for patients with intractable focal epilepsy. However, careful monitoring of adverse events is essential from treatment initiation, with particular attention to psychological problems in adolescents and young adults.
作为最新的抗癫痫药物之一，吡仑帕奈（PER）的相关研究有限。本研究旨在评估吡仑帕奈作为附加疗法治疗难治性局灶性癫痫患者的长期疗效和耐受性。
回顾性分析97例年龄在12至30岁患者的病历。这些患者被诊断为局灶性癫痫，接受了吡仑帕奈治疗，并进行了为期12个月的定期随访。
尽管使用了两种或更多种抗癫痫药物治疗，但所有患者的癫痫发作均未得到控制。癫痫发作的平均起始年龄为5.2岁（范围0至17.0岁）。吡仑帕奈首次处方的平均年龄为15.7岁（范围12.0至25.3岁），开始使用吡仑帕奈后的平均随访时间为15.9个月（范围12至20个月）。缓解率为41.7%，11例（15.3%）癫痫发作减少超过75%，其中3例无癫痫发作（4.2%）。随访3、6、12和18个月时的保留率分别为82.5%（80/97）、72.1%（70/97）、60.8%（59/97）和37.5%（6/16）。44例患者（44/97，45.4%）停用了吡仑帕奈，其中20例（20.6%）是因为治疗相关不良事件，24例（24.7%）是因为无效。52例患者（53.6%）报告了治疗相关不良事件。最常见的不良事件是嗜睡或乏力，17例患者（17/97，23%）报告，其次是头晕（15/97，20%）以及攻击性或易怒等心理问题（15/97，20%）。33例患者（33/52，63.4%）在吡仑帕奈剂量为2或4mg/天时首次出现不良症状。
吡仑帕奈对于难治性局灶性癫痫患者是一种有效的治疗选择。然而，从治疗开始就必须仔细监测不良事件，尤其要关注青少年和青年患者的心理问题。
