Evaluate the efficacy and side-effect profile of Perampanel as adjunctive therapy for refractory epilepsy.

Epilepsy affects approximately 1.2 million Americans and 30% of them remain medically intractable. Newly FDA-approved medications are of interest for patients who have failed multiple classes of antiepileptic drugs (AEDs) and/or surgical procedures. Perampanel is an orally active, non-competitive AMPA-type glutamate receptor antagonist approved for adjunctive treatment of refractory epilepsy based on the efficacy and safety results of Phase III double-blind studies. Perampanel was shown to reduce seizure frequency in patients receiving 1-3 concomitant AEDs.

Retrospective review conducted on patients who were 12 years of age or older treated with perampanel at Baylor Scott&White Hospital/Texas A&M College of Medicine in Temple, TX. Subject data were acquired from electronic medical records. Approval was given by our hospital's Institutional Review Board. Patient demographics included age, gender, epilepsy type, concomitant/failed anticonvulsants, and seizure frequency. Outcome measures were efficacy and tolerability of perampanel. 

A total 18 patients met our inclusion criteria. Demographics included 12 males (66%), 6 females (33%), ages ranging 14-75 years. Partial epilepsy was diagnosed in 12 patients (66%) and generalized epilepsy in 6 (33%). The majority of patients, 13 (72.2%), were on 1-3 AEDs, 3 (17%) were on 0-1 AED, and 2 (11.1%) were on 4+ AEDs prior to receiving perampanel. Starting doses were 2-4mg daily, maintenance 4-8mg daily. Primary objective was response to perampanel: seizure frequency reduction in 12 (66.6%), no change in 3 (16.6%), and increased frequency in 3 (16.6%). A total of 8 (44.4%) patients came off perampanel; 5 (27.7%) due to aggressiveness/behavioral changes, 3 (16.6%) had sedation, dizziness, or ineffectiveness. Follow-up was 3 months - 1 year in clinic. 

Study limited by small sample size. Perampanel was beneficial in patients with refractory partial or generalized epilepsy as adjunctive therapy. Mostly behavioral side-effects were observed.