Usefulness of perampanel with concomitant levetiracetam for patients with drug-resistant epilepsy

• Published in: European journal of paediatric neurology 2019-01, Vol.23 (1), p.197-203
• Main Authors: Kanemura, Hideaki, Sano, Fumikazu, Aihara, Masao
• Format: Article
• Language: English
• Subjects: Aggression; Children; Concomitant treatment; Drug-resistant epilepsy; Levetiracetam (LEV); Perampanel (PER)
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2018.10.004

The purpose was to evaluate the efficacy of treatment and the occurrence of aggression-related adverse events among children receiving perampanel (PER) with concomitant levetiracetam (LEV). Patients were selected according to the following criteria: 1) between 12 and 18 years old; 2) seizures refractory to at least 2 first-line drugs; 3) at least 4 seizures a month before PER administration; and 4) at least 12 months of follow-up. Patients were subdivided into groups with and without LEV as concomitant treatment. PER was administered at a dose of 2 mg/day, increasing by 2 mg/day every 2 weeks up to 12 mg/day if seizures appeared. In comparison with the baseline seizure frequency, response to PER treatment was classified as follows: complete cessation (100% seizure control); response (≥50% reduction in seizures); and exacerbation (≥50% increase in seizures). Responders were identified as patients showing complete cessation or response. The study group comprised 39 outpatients with a mean age of 13.7 years at enrollment. Responder status was seen in 13 of the 19 patients with LEV and 4 of the 20 patients without LEV. PER appeared significantly more effective in patients with LEV than in those without LEV (p = 0.0076). Seizure-free status was significantly more frequent among patients with LEV (47.4%) than among those without LEV (15.0% (p = 0.0407)). Aggression was present in 2 patients without LEV, but none with LEV. The present study suggests the utility of PER with concomitant LEV for children with drug-resistant epilepsy. •We investigated the usefulness among children receiving PER with concomitant LEV.•PER appeared more effective in patients with LEV than in those without LEV.•Seizure-free status was significantly more frequent among patients with LEV.•Aggression was present in 2 patients without LEV, but none with LEV.•The present study suggests the utility of PER with concomitant LEV for children.