title: Clinical experience with perampanel: focus on psychiatric adverse effects.
abstract: BACKGROUND
  Perampanel (PER) is a novel antiepileptic drug that inhibits the AMPA class of glutamate receptors. It has been available in the UK since September 2012. We undertook a retrospective analysis of efficacy and tolerability of PER in 47 patients with drug-refractory epilepsy attending a regional epilepsy service in the UK.
  
  
  METHODS
  Demographic and clinical data of patients with refractory epilepsy prescribed PER were collected by review of records. Efficacy, as measured by responder rates (>50% reduction in seizure frequency), retention rates, and adverse effects, was analyzed.
  
  
  RESULTS
  Of the 47 patients prescribed PER, 39 (87%) had focal epilepsy, four (9%) had idiopathic generalized epilepsy, 3 (6%) had symptomatic generalized epilepsy, and 1 had unclassified epilepsy. Patients were taking a median of 2 AEDs (range: 1-5) when starting on PER. The median dose of PER was 8 mg (range: 2-12 mg). Thirteen (28%) patients were classed as responders, but no patients experienced sustained seizure freedom. Twenty-one (45%) patients had withdrawn from PER during the study period, with 16 (76%) of them withdrawing due to intolerable adverse effects, 4 due to inadequate seizure control, and 1 due to the combination of both. The most frequent adverse effects requiring withdrawal from PER were behavioral reactions including suicidal ideation (n = 2), aggressive behavior (n = 2), and both (n = 1).
  
  
  CONCLUSIONS
  In our experience, PER had a retention rate of 55% and a responder rate of 28%. Psychiatric adverse effects, including suicidal ideation, were the most common reasons for withdrawal.
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Coyle
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Clough
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK; University of Manchester, Manchester, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cooper
authors.affiliation: Greater Manchester Neurosciences Centre, Salford Royal Hospital, UK; University of Manchester, Manchester, UK. Electronic address: Rajiv.Mohanraj@srft.nhs.uk.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mohanraj
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D064420:Drug-Related Side Effects and Adverse Reactions; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009570:Nitriles; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D012189:Retrospective Studies; D059020:Suicidal Ideation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; C551441:perampanel
keywords: Epilepsy; Perampanel; Suicidality