title: Perampanel as add-on treatment in refractory focal epilepsy. The Dianalund experience.
abstract: BACKGROUND
  Perampanel (PER) is an antagonist of AMPA receptors that has been approved for adjunctive treatment of partial-onset seizures.
  
  
  OBJECTIVE
  To evaluate effectiveness and safety of PER as add-on treatment in patients with severely refractory focal epilepsy.
  
  
  METHODS
  PER was introduced as add-on treatment in 22 consecutive patients with drug-resistant focal epilepsy. PER was started with 2 mg/day at bedtime and was up-titrated by 2 mg/day every 2-4 weeks.
  
  
  RESULTS
  All patients suffered from severely refractory focal epilepsy (86% took 2 or more AEDs prior PER initiation; 40% had been submitted to surgery or were surgery candidates; 7 had VNS). After 12 months since PER initiation, the retention rate was 54.5% and the responder rate was 27.2%, including 9.1% seizure-free patients. Mean PER dose in the responders was 8 mg/day (range 4-10). Most common side effects were tiredness, behavioral changes (primarily aggressivity), dizziness and were reported in 59.1% of patients, leading to PER discontinuation in 31.8% of subjects.
  
  
  CONCLUSIONS
  PER as add-on treatment can achieve clinically meaningful improvement in patients suffering from severely refractory focal epilepses. Further studies are warranted to explore the tolerability profile, with particular focus on psychiatric adverse events.
authors.affiliation: Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Juhl
authors.affiliation: Danish Epilepsy Center, Filadelfia/University of Copenhagen, Dianlund, Denmark. guru@filadelfia.dk.|IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy. guru@filadelfia.dk.
authors.forename: G
authors.initials: G
authors.lastname: Rubboli
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004828:Epilepsies, Partial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; C551441:perampanel
keywords: drug-refractory focal epilepsy; efficacy; perampanel; psychiatric adverse events; safety; tolerability