Fong Yi-On, Huang Poyin, Hsu Chung Yao, Yang Yuan-Han
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Clin Neurol. 2022 Nov;18(6):653-662. doi: 10.3988/jcn.2022.18.6.653.
Thoroughly acquainting physicians with the effects of antiseizure medications (ASMs) is essential for developing appropriate therapeutic regimens for seizure management. This review summarizes the available evidence regarding patients receiving the antiseizure agent perampanel (PER) and its effects on the cognition, behavior, and psychological status of patients.
The PubMed and Google Scholar databases were searched for all relevant articles published during 2015-2021 and without any other publication limitations, and also manually searched the reference lists in the identified articles. Outcomes of interest were changes in seizure frequency relative to baseline, 50% responder rate, seizure-free rate, and retention rate (proportion of participants continuing PER at study endpoints). Safety outcomes included adverse effects and the percentage of patients experiencing effects on cognitive, psychiatric, and behavioral symptoms.
We identified 139 studies, of which 28 were included after screening. Most studies found reduced seizure frequencies and satisfactory responder and retention rates, demonstrating the effectiveness and tolerability of PER. No negative effects were found for cognitive function, but a nonnegligible impact on aggressive behavior was noted when compared with other ASMs. Patients with previous psychiatric comorbidities had a greater risk of psychiatric side effects under PER treatment. PER induces an overall improvement in quality of life.
After synthesizing the study results, PER was a safe and effective choice as an additional therapy for patients with refractory epilepsy. A comprehensive evaluation of behavior and psychiatric risk is suggested before implementing PER.
让医生全面了解抗癫痫药物（ASM）的作用对于制定合适的癫痫治疗方案至关重要。本综述总结了关于接受抗癫痫药物吡仑帕奈（PER）治疗的患者及其对患者认知、行为和心理状态影响的现有证据。
检索PubMed和谷歌学术数据库中2015年至2021年发表的所有相关文章，且无任何其他发表限制，并手动检索已识别文章中的参考文献列表。感兴趣的结果包括相对于基线的癫痫发作频率变化、50%缓解率、无癫痫发作率和留存率（研究终点时继续使用PER的参与者比例）。安全性结果包括不良反应以及经历认知、精神和行为症状影响的患者百分比。
我们识别出139项研究，筛选后纳入28项。大多数研究发现癫痫发作频率降低，缓解率和留存率令人满意，证明了PER的有效性和耐受性。未发现对认知功能有负面影响，但与其他ASM相比，发现对攻击性行为有不可忽视的影响。既往有精神疾病合并症的患者在接受PER治疗时出现精神副作用的风险更高。PER可使生活质量总体得到改善。
综合研究结果后，PER作为难治性癫痫患者的附加治疗是一种安全有效的选择。建议在使用PER之前对行为和精神风险进行全面评估。
