Department of Neurology, Kyoto University Graduate School of Medicine, Japan.
Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan; Department of Futaba Emergency General Medicine Supportive Center, Fukushima Medical University, Japan.
Clin Neurophysiol. 2019 Oct;130(10):1804-1812. doi: 10.1016/j.clinph.2019.07.006. Epub 2019 Jul 19.
To elucidate the effects of perampanel (PER) on refractory cortical myoclonus for dose, etiology and somatosensory-evoked potential (SEP) findings.
We examined 18 epilepsy patients with seizure and cortical myoclonus. Based on data accumulated before and after PER treatment, correlations among clinical scores in myoclonus and activities of daily life (ADL); early cortical components of SEP; and PER blood concentration, were analyzed.
PER (mean dose: 3.2 ± 2.1 mg/day) significantly improved seizures, myoclonus and ADL and significantly decreased the amplitude of and prolonged latency of giant SEP components. The degree of P25 and N33 prolongations (23.8 ± 1.6 to 24.7 ± 1.7 ms and 32.1 ± 4.0 to 33.7 ± 3.4 ms) were significantly correlated with improved ADL score (p = 0.019 and p = 0.025) and blood PER concentration (p = 0.011 and p = 0.025), respectively.
Low-dose PER markedly improved myoclonus and ADL in patients with refractory cortical myoclonus. Our results suggest that SEP, particularly P25 latency, can be used as a potential biomarker for assessing the objective effects of PER on intractable cortical myoclonus.
In this study, PER lessened the degree of synchronized discharges in the postsynaptic neurons in the primary motor cortex.
阐明吡仑帕奈（PER）对难治性皮质肌阵挛的作用，包括剂量、病因和体感诱发电位（SEP）的发现。
我们检查了 18 例癫痫伴发癫痫发作和皮质肌阵挛的患者。根据 PER 治疗前后的数据，分析肌阵挛和日常生活活动（ADL）的临床评分之间、SEP 的早期皮质成分之间、以及 PER 血药浓度之间的相关性。
PER（平均剂量：3.2±2.1mg/天）显著改善了癫痫发作、肌阵挛和 ADL，显著降低了巨大 SEP 成分的振幅和潜伏期。P25 和 N33 延长的程度（23.8±1.6ms 至 24.7±1.7ms 和 32.1±4.0ms 至 33.7±3.4ms）与 ADL 评分的改善（p=0.019 和 p=0.025）和 PER 血药浓度（p=0.011 和 p=0.025）显著相关。
低剂量 PER 显著改善了难治性皮质肌阵挛患者的肌阵挛和 ADL。我们的结果表明，SEP，特别是 P25 潜伏期，可以作为评估 PER 对难治性皮质肌阵挛客观疗效的潜在生物标志物。
在这项研究中，PER 减轻了初级运动皮层中突触后神经元同步放电的程度。
