Efficacy of Perampanel in Nocturnal Seizures in Adult Patients with Epilepsy

Abstract

Objective. Nocturnal seizures are usually underestimated and represent a major problem in adult patients with epilepsy. Our aim was to study the effectiveness of perampanel for the treatment of nocturnal seizures in adult patients with epilepsy. Methods. Observational study of a prospectively acquired sample of adult patients with focal and generalized epilepsy in which perampanel was started from January to October 2021 in a specialized epilepsy unit in a tertiary hospital. Demographic and clinical characteristics were recorded. All patients completed a follow-up period of at least 3 months. Seizure frequency during the 6-month period before the patient started treatment was obtained from medical records. Retention and responder rates (considered as a nocturnal seizure frequency reduction of ≥50%) and improvement of subjective sleep disturbances were analyzed as outcome measures. Results. Forty-eight patients were included (mean age $39.8\pm 17.4$; 60.4% men), and 38 of them had a 6-month follow-up. Focal epilepsy was the most common diagnosis (81.3%), and most patients had a structural etiology (56.3%). Thirty-four (70.8%) patients had drug-resistant epilepsy. The mean nocturnal seizure frequency per month at baseline was $13.2\pm 35.9$. Fifteen (31.3%) patients had subjective sleep disturbances at baseline, of which insomnia was the most frequent complaint (16.7%). Perampanel was started at a median dose of 4 mg/day ($\text{range}=2$-14). At 3-month follow-up, the retention rate was 74.6%; 64.6% were considered responders (54.2% were seizure-free). Monthly nocturnal seizures decreased significantly at 3 months ($8.2\pm 26.7$ vs. $13.2\pm 35.9$ seizures/month; $p=0.044$) and 6 months ($5.3\pm 18.2$ vs. $13.2\pm 35.9$ seizures/month; $p=0.006$). Subjective sleep disturbances improved at 3-month follow-up (10.4% vs. 31.3%; $p=0.002$) and 6-month follow-up (10.5% vs. 31.3%; $p=0.022$). Significance. Perampanel can be a suitable treatment option in adult patients with both focal and generalized epilepsy with nocturnal seizures and can reduce the presence of sleep complaints.