title: Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures.
abstract: The purpose of this study was to evaluate subjective sleep quality and daytime sleepiness in patients receiving adjunctive perampanel for focal seizures.
  
  
  
  We conducted a multicenter, prospective, interventional, open-label study in patients aged >16 with focal seizures who received adjunctive perampanel (flexible dosing: 2-12mg). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS) at baseline and 3 and 6months after initiating perampanel. Patients with modifications in their baseline AEDs or sleep medications were excluded.
  
  
  
  In 72 patients with drug-resistant focal seizures, mean baseline PSQI score (±standard deviation) was 7.26 (±4.6), and ESS was 6.19 (±4.2). At 3months (median perampanel dose: 4mg), there was no significant mean change from baseline in ESS score (n=61) and a significant improvement in PSQI (-1.51 points; n=44; p=0.007), driven mainly by improved sleep efficiency (p=0.012). In the 31 patients with 6-month data, ESS (but not PSQI) improved significantly at 6months vs baseline (p=0.029). The only factor significantly correlated with sleep parameters was number of baseline AEDs (higher number correlated with worse daytime sleepiness). Seizure frequency was reduced significantly from baseline at 3 and 6months. In bivariate analysis, neither PSQI nor ESS was associated with seizure frequency, suggesting that the changes in daytime sleepiness and sleep quality may be independent of the direct effect on seizures.
  
  
  
  Adjunctive perampanel did not worsen sleep quality or daytime sleepiness at 3months and reduced daytime sleepiness in patients continuing perampanel for 6months. Perampanel may be a suitable AED in patients with sleep disorders, in addition to refractory focal seizures.
authors: Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: mtoledo@vhebron.net.
authors: Manuel
authors: M
authors: Toledo
authors: Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Montserrat
authors: M
authors: Gonzalez-Cuevas
authors: Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain.
authors: Julia
authors: J
authors: Miró-Lladó
authors: Epilepsy Unit, Neurology Department, Josep Trueta University Hospital, Girona, Spain.
authors: Albert
authors: A
authors: Molins-Albanell
authors: Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain.
authors: Mercé
authors: M
authors: Falip
authors: Neurology Department, Son Espases Hospital, Palma de Mallorca, Spain.
authors: Ana Belén
authors: AB
authors: Martinez
authors: Neurology Department, Hospital Plató, Barcelona, Spain.
authors: Santiago
authors: S
authors: Fernandez
authors: Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Manuel
authors: M
authors: Quintana
authors: Sleep Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Roser
authors: R
authors: Cambrodi
authors: Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Estevo
authors: E
authors: Santamarina
authors: Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Javier
authors: J
authors: Salas-Puig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D011446:Prospective Studies; D011728:Pyridones / Q000009:adverse effects* / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy*; D012893:Sleep Wake Disorders / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; C551441:perampanel
keywords: AED load; AMPA receptor; Epilepsy; Glutamate; Sleep quality; Somnolence