News Topics: Treatments

Antiepileptic Drug Effects on Aubjective and Objective Cognition

RATIONALE: Cognitive impairment is one of the most common complaints for persons with epilepsy (PWE). These impairments are not only associated with seizures, but are also regularly reported as adverse effects of antiepileptic drugs (AEDs). Previous studies have examined cognitive effects of both AED monotherapy and polytherapy, yet there is limited research on these differences with respect to both subjective and objective cognition. The current study uses data from previous research conducted by the Centers for Disease Control and Prevention (CDC)-sponsored Managing Epilepsy Well (MEW) Network collaborative. We used three distinct archival datasets from the following: (1) the HOBSCOTCH efficacy trial at Dartmouth-Hitchcock Medical Center (HOB-1), (2) the multisite replication trial (HOB-2), and (3) epilepsy self-management research conducted at the NYU School of Medicine.

METHODS: This retrospective analysis combined baseline data from three datasets to determine how the number of AEDs and the type of AEDs were associated with subjective (patient-reported) and objective (examiner-assessed) cognition. Subjective cognition was captured using the cognitive subscale of the Quality of Life in Epilepsy Inventory (QOLIE-31) in all three datasets (n = 224), while objective cognition was measured using the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) in the HOB-1 dataset (n = 65) and the Brief Test of Adult Cognition by Telephone (BTACT) in the HOB-2 dataset (n = 91). Multivariable linear regression was utilized for our initial assessments, followed by propensity score matching to provide stronger control of covariates. Matching was based on significantly different covariates, such as education, depression, and history of prior epilepsy surgery. Nonparametric statistical tests were utilized to compare these matched subjects.

RESULTS: Subjective cognitive impairment was significantly worse among individuals on monotherapy (1 AED) compared with those on polytherapy (2+ AEDs) (adjusted p = 0.041). These findings were consistent with the propensity score matched comparison of monotherapy and polytherapy, which indicated that polytherapy was associated with worse overall subjective cognition (adjusted p = 0.01), in addition to impairments on the RBANS (Total score p = 0.05) and specific subdomains of the BTACT (Episodic Verbal Memory p < 0.01, Working Memory p < 0.01, Processing Speed p < 0.01). Interestingly, older generation AEDs were associated with better language performance than newer generation and combined generation AED therapy (RBANS Language p = 0.03). These language-specific findings remained significant after controlling for the effects of topiramate and zonisamide (p = 0.04).

CONCLUSIONS: A greater number of antiepileptic drugs (AEDs) is significantly and negatively associated with subjective and objective cognition in people with epilepsy, and is in line with previous research. Antiepileptic drug type did not, in itself, appear to be associated with subjective cognition. These findings suggest that ineffective AEDs should be replaced, rather than introducing additional AEDs to a treatment regimen. Further, while subjective and objective cognition assessments were both sensitive at detecting differences based on AED status, the neuropsychological objective subdomains offer additional and specific insights into how cognition is impaired with AEDs.

Study Suggests that FDA-Approved Drug Riluzole can be Pepurposed to Treat Epilepsies Caused by Kv1 Channel Disorders

Objective: Ion channels belonging to subfamily A of voltagegated potassium channels (Kv1) are highly expressed on axons, where they play a key role in determining resting membrane potential, in shaping action potentials, and in modulating action potential frequency during repetitive neuronal firing. This team aimed to study the genesis of seizures caused by mutations affecting Kv1 channels and searched for potential therapeutic targets.

Methods: This research team used a novel in silico model, the Laminar Cortex Model (LCM), to examine changes in neuronal excitability and network dynamics associated with loss-of-function mutations in Kv1 channels. The LCM simulates the activities of a network of tens of thousands of interconnected neurons and incorporates the kinetics of 11 types of ion channel and three classes of neurotransmitter receptor. Changes in two types of potassium currents conducted by Kv1 channels were examined: slowly inactivating D-type currents and rapidly inactivating A-type currents. Effects on neuronal firing rate, action potential shape, and neuronal oscillation state were evaluated. A systematic parameter scan was performed to identify parameter changes that can reverse the effects of the changes.

Results: Reduced axonal D-type currents led to lower firing threshold and widened action potentials, both lowering the seizure threshold. Two potential therapeutic targets for treating seizures caused by loss-of-function changes in Kv1 channels were identified: persistent sodium channels and NMDA receptors. Blocking persistent sodium channels restored the firing threshold and reduced action potential width. NMDA receptor antagonists reduced excitatory postsynaptic currents from excessive glutamate release related to widened action potentials.

Significance: Riluzole reduces persistent sodium currents and excitatory postsynaptic currents from NMDA receptor activation. The researchers state that these results suggest that this FDA-approved drug can be repurposed to treat epilepsies caused by mutations affecting axonal Kv1 channels.

Systematic Review Highlights That Clinicians Should Be Aware of Possible Skin-related Drug Reactions to Levetiracetam

PURPOSE: Recently, there have been an increased number of reports on levetiracetam (LEV) induced cutaneous adverse drug reactions (CADRs). This research team aimed to identify and critically evaluate all the descriptive studies on LEV induced-CADRs and to describe the possible clinical manifestations, management, and treatment outcomes of the condition.

METHODOLOGY: PubMed and grey literature databases were searched from inception to June 2019 without any restriction. The team also performed a bibliographic search for additional studies. Only descriptive studies on LEV-induced CADRs were included for our review. Study selection, data abstraction and quality assessment were performed by two contributors independently and disagreements were settled through consensus or through discussion with a third reviewer.

RESULTS: Data from 24 out of 88 studies, which included 25 patients (12 female and 13 male) aged from 40 weeks to 73 years, were reviewed. Patients received between 500 mg/day to 3000 mg/day of LEV. Drug reaction with eosinophilia and systemic symptoms syndrome, Steven-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, generalised hyperpigmentation and leucocytoclastic vasculitis were observed among the included patients. Immediate cessation of LEV, providing supportive care and use of topical antihistamines and anti-inflammatory drugs appeared to be the mainstay of management, and all patients were found to have recovered.

CONCLUSION: Clinicians should be aware of the possible cutaneous adverse drug reactions induced by levetiracetam to avoid the development of a potentially fatal condition. Immediate withdrawal of the drug and supporting care seem to be effective in the management of the cutaneous adverse drug reactions.

Epilepsy Research Findings: January 2020

This past month of research advances include the finding that “silencing” certain populations of neurons may stop seizures and the uncovering of a possible cause of memory impairments in individuals with epilepsy. In addition, a study found that one in every four children in the US with epilepsy has anxiety and/or depression, emphasizing the importance of investing resources into epilepsy and mental health.

Other exciting news for the epilepsy community includes the approval of a new nasally administered rescue medication called VALTOCO and the expanded availability of the no-cost epilepsy gene panel testing program Behind the Seizure® to a wider age range of children who have had an unprovoked seizure.

Summaries of these research discoveries and news highlights are below.

Research Discoveries & News

  • Seizure Control: Seizures can be “switched off” in an animal model of epilepsy by silencing one particular set of neurons located in the brainstem, specifically in an area called the substantia nigra, according to research from the Georgetown University Medical Center. Zeroing in on specific neurons suggests that treatment for epilepsy can be improved, researchers say. Learn More
  • Epilepsy and Memory: A new Cedars-Sinai study reveals how memory and abnormal brain activity are linked in patients with epilepsy. The data show that abnormal electrical pulses from specific brain cells are associated with a temporary kind of memory disruption called transient cognitive impairment. Learn More
  • Epilepsy and Depression: A study utilizing data from the 2009-2010 National Survey of Children with Special Health Care Needs found that one in four US children with epilepsy has depression and/or anxiety. The study authors concluded that physicians should consider the various factors that are related to depression and anxiety in children with epilepsy so that at-risk children can be screened and managed appropriately. Learn More
  • Treatment Approval: Neurelis, Inc. announced that the FDA has approved VALTOCO® (diazepam nasal spray) as an acute treatment of intermittent, stereotypic episodes of frequent seizure activity (seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in people with epilepsy 6 years of age and older. Learn More
  • Genetic Testing: The no-cost epilepsy gene panel testing program Behind the Seizure®, which aims to provide faster diagnosis for young children with epilepsy, is being extended to any child under the age of eight who has an unprovoked seizure. Learn More

The CURE Epilepsy Research Mobile App delivers research news to the palm of your hand! With frequent updates, you’ll always be in-the-know about the latest in epilepsy science. Download today. iOS | Android

Lamotrigine Tablets Drug Label

Taro Pharmaceuticals Press Release: Voluntary Nationwide Recall of Lamotrigine Tablets USP, 100 mg, 100 Count Bottles

Taro Pharmaceuticals U.S.A., Inc. (“Taro” or the “Company”) is voluntarily recalling one (1) lot of Lamotrigine 100 mg Tablets, Lot # 331771 (expiration date June 2021) in 100 count bottles, NDC 51672-4131-1 to the consumer level. This single lot of Lamotrigine 100 mg Tablets Lot #331771 (expiration date June 2021) was found to have been cross-contaminated with a small amount of another drug substance (Enalapril Maleate) used to manufacture another product at the same facility.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200110005522/en/

Risk Statement: Use of Lamotrigine 100 mg Tablets could potentially result in exposure to a small amount of Enalapril Maleate, if present in the product in question. Enalapril Maleate is a drug substance indicated for hypertension and congestive heart failure. There is potential with chronic exposure to Enalapril Maleate to impact users particularly if they are small children or pregnant women. Enalapril Maleate is also associated with risk of birth defects in a developing fetus. Therefore, there is risk associated with the continued, long-term use of Lamotrigine 100 mg Tablets, Lot # 331771 (expiration date June 2021).

Taro has not received any product complaints or adverse events related to contamination of this product with Enalapril, or any complaints or adverse events that are associated specifically with this recall. Taro will continue to actively monitor for any and all adverse event reports that may be received, in compliance with FDA regulatory requirements.

Lamotrigine 100 mg Tablets are indicated for Epilepsy and Bipolar disorder. This product is packaged in white plastic bottles with screw cap closure, and each bottle contains 100 tablets. Each bottle is labeled to indicate the name of the product, Lamotrigine Tablets USP, 100 mg, the NDC #51672-4131-1 (see image of container label below), the lot number 331771 and expiration date of June 2021.

Lamotrigine 100 mg Tablets, Lot # 331771 were distributed to wholesale distributors in the US market between August 23 and August 30, 2019. These wholesale customers may have further distributed Lot # 331771 to retail pharmacies for prescription dispensing to patients who were prescribed 100 mg Lamotrigine Tablets.

Taro is notifying its distributors and customers by Phone, E-mail, and Letters via US Mail and is arranging for return of any containers or quantities of Lamotrigine 100 mg Tablets, Lot # 331771 (exp. June 2021). Consumers that have any quantities of Lamotrigine 100 mg Tablets, Lot # 331771 being recalled should stop using this product and return it to the pharmacy that dispensed it. Retailers, pharmacies and distributors should stop distributing or dispensing this product and return it to Taro.

Consumers with questions regarding this recall can contact Taro by calling 1-866-923-4914 or by e-mail at TaroPVUS@taro.com, Monday through Friday between 7:00 AM and 7:00 PM US Central Time. Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using this drug product.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

  • Complete and submit the report Online
  • Regular Mail or Fax: Download form or call 1- 800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

Hand holding Valtoco Nasal Spray

Neurelis Press Release: FDA Approval for Seizure Rescue Medication VALTOCO

Neurelis Press Release

Highlights:

  • VALTOCO (diazepam nasal spray) is approved by the U.S. Food and Drug Administration (FDA) for use by a care partner outside of the medical setting for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern
  • VALTOCO is the first nasal spray approved by the FDA as a rescue treatment for people with epilepsy aged 6 and older
  • VALTOCO’s proprietary formulation including Intravail® has been shown to be generally safe and well tolerated
  • VALTOCO granted Orphan Drug Exclusivity by the FDA

SAN DIEGO, CA – January 13, 2020:

Neurelis, Inc., today announced that the U.S. Food and Drug Administration (FDA) has approved VALTOCO® (diazepam nasal spray) as an acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in people with epilepsy 6 years of age and older. The unique formulation of VALTOCO incorporates Intravail® for consistent and reliable absorption.

“Cluster or acute repetitive seizures are challenging to treat and highly disruptive in the lives of people with epilepsy,” said Neurelis President and CEO Craig Chambliss. “VALTOCO was developed to provide an effective combination of reliability, safety and tolerability in a ready-to-use nasal spray. This is a defining moment for Neurelis as VALTOCO is our first FDA-approved product. We are excited that we can now offer this treatment option to patients and provide additional support to the epilepsy community.”

Chambliss added that VALTOCO was also granted seven years of Orphan Drug Exclusivity by the FDA Office of Orphan Products Development.

VALTOCO is a proprietary formulation of diazepam incorporating the Science of Intravail. Intravail transmucosal absorption enhancement technology enables the non-invasive delivery of a broad range of protein, peptide and small molecule drugs. In the United States, there are over 3.4 million people with epilepsy, with approximately 200,000 new patients diagnosed each year. Despite the availability of chronic, daily oral medications to control epilepsy, a significant number of these patients continue to experience seizures. Of these uncontrolled patients, as many as 170,000 are at risk for episodes of frequent seizure activity, also known as cluster or acute repetitive seizures, representing a significant unmet need in the epilepsy community.

“This is an important development in the epilepsy community,” said R. Edward Hogan, MD, Director of the Washington University and Barnes-Jewish Epilepsy Center in St. Louis. “Most seizures that require intervention are treated in an inconvenient manner. To be able to reliably treat seizure activity when and where it happens with a caregiver-administered option like VALTOCO is a significant step forward. The availability of VALTOCO may positively impact the lives of thousands of people with epilepsy who experience cluster or acute repetitive seizures and their care partners.”

In a long-term, open-label, repeat dose, clinical trial, the safety of VALTOCO was evaluated: over 130 patients were enrolled and more than 2,000 seizures were treated. The clinical trial included patients aged 6 and above. “Until recently, approved treatment outside of medical care settings was only available as a rectally administered medication,” Dr. Hogan said. “The FDA approval of diazepam nasal spray is a significant advancement for the epilepsy community.”

Enrique Carrazana, MD, Chief Scientific Officer for Neurelis, notes that VALTOCO was generally safe and well tolerated during clinical studies. The most common adverse reactions (at least 4%) were somnolence, headache, and nasal discomfort.

Jacqueline A. French, MD, professor in the Department of Neurology at NYU Langone Health’s Comprehensive Epilepsy Center and Chief Medical & Innovation Officer for the Epilepsy Foundation, commented, “One of the goals of rescue therapy is to treat seizure clusters, recognized as medical emergencies, before negative consequences may be experienced. These consequences may include injury and seizure progression to status epilepticus. Having a seizure rescue treatment that is generally safe, reliable and ready-to-use is very empowering. We encourage all epilepsy patients to work with their doctors to make sure they have a seizure rescue treatment plan in place.”

Please click on this link for full Prescribing Information, including Boxed Warning, and Medication Guide.

Indication

VALTOCO® (diazepam nasal spray) is indicated for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (ie, seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in patients with epilepsy 6 years of age and older.

IMPORTANT SAFETY INFORMATION

RISK FROM CONCOMITANT USE WITH OPIOIDS

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate
  • Limit dosages and durations to the minimum required
  • Follow patients for signs and symptoms of respiratory depression and sedation

Contraindications: VALTOCO is contraindicated in patients with:

  • Known hypersensitivity to diazepam
  • Acute narrow-angle glaucoma

Central Nervous System (CNS) Depression

Benzodiazepines, including VALTOCO, may produce CNS depression. Caution patients against engaging in hazardous activities requiring mental alertness, such as operating machinery, driving a motor vehicle, or riding a bicycle, until the effects of the drug, such as drowsiness, have subsided, and as their medical condition permits.

The potential for a synergistic CNS-depressant effect when VALTOCO is used with alcohol or other CNS depressants must be considered, and appropriate recommendations made to the patient and/or care partner.

Suicidal Behavior and Ideation

Antiepileptic drugs (AEDs), including VALTOCO, increase the risk of suicidal ideation and behavior. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or unusual changes in mood or behavior. Advise patients and caregivers to be alert for these behavioral changes and to immediately report them to a healthcare provider.

Glaucoma

Benzodiazepines, including VALTOCO, can increase intraocular pressure in patients with glaucoma. VALTOCO may only be used in patients with open-angle glaucoma only if they are receiving appropriate therapy. VALTOCO is contraindicated in patients with narrow-angle glaucoma.

Risk of Serious Adverse Reactions in Infants due to Benzyl Alcohol Preservative

VALTOCO is not approved for use in neonates or infants. Serious and fatal adverse reactions, including “gasping syndrome”, can occur in neonates and low-birth-weight infants treated with benzyl alcohol-preserved drugs, including VALTOCO. The “gasping syndrome” is characterized by central nervous system depression, metabolic acidosis, and gasping respirations. The minimum amount of benzyl alcohol at which serious adverse reactions may occur is not known.

Adverse Reactions

The most common adverse reactions (at least 4%) were somnolence, headache, and nasal discomfort.

Diazepam, the active ingredient in VALTOCO, is a Schedule IV controlled substance.

To report SUSPECTED ADVERSE REACTIONS, contact Neurelis, Inc. at 1-866-696-3873 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Please read full Prescribing Information, including Boxed Warning, for additional important safety information.

MORE INFORMATION ON VALTOCO

For more information on VALTOCO, please visit www.valtoco.com. Neurelis has also launched a patient support program, myNEURELIS™ (1-866-696-3873). myNEURELIS is designed as a flexible program, which allows patients and care partners to personally select their desired support services.

About Neurelis

Neurelis, Inc. is an innovation-driven neuroscience company providing a highly differentiated approach to target unmet medical needs. Neurelis is focused on the development and commercialization of product candidates for epilepsy and the broader central nervous system (CNS) market. In addition to VALTOCO, the company is developing NRL-2 for intermittent use to control acute anxiety episodes or panic attacks; NRL-3 as a noninvasive acute therapy to stop seizures that have progressed to status epilepticus; and NRL-4 as a noninvasive rescue therapy to address the escalation of psychomotor agitation (PMA) symptoms outside the medical setting. The Neurelis technology platform includes Intravail®, ProTek® and Hydrogel®, three proprietary, noninvasive drug-delivery and stabilization technologies applicable to a wide range of molecules, including therapeutic proteins, peptides, non-peptide macromolecules and small molecules. For more information on Neurelis, please visit www.neurelis.com.

Dravet Syndrome: Treatment Options and Management of Prolonged Seizures

Over time, with careful delineation of Dravet syndrome, doctors have gained experience in treatments most likely to lead to improvement in seizures, as well as those that should be avoided. Sodium valproate, clobazam, stiripentol, and topiramate are all medications that may lead to benefit, as well as the ketogenic diet. Bromides may be utilized in resistant cases. However, equally important are outlining prompt rescue treatment for prolonged seizures and avoidance of precipitants. Newer agents including cannabidiol and fenfluramine have been demonstrated to be of benefit in clinical trials. This study proposes an algorithm for management, but appreciate that the positioning of newer agents is yet to be established.

Key Points

  • An early accurate diagnosis is key to optimal treatment in Dravet syndrome
  • Prompt rescue treatment with personalized protocols for prolonged seizures is key, as well as avoidance of precipitants of seizures
  • Clobazam, stiripentol, valproate, and more recently cannabidiol appear to be effective treatments
  • Fenfluramine is a promising agent demonstrating specific efficacy in trials and should be considered for the future

FYCOMPA® for adjunctive treatment of partial onset seizures launched in China

Eisai announced that it has launched the in-house discovered and developed antiepileptic drug (AED) Fycompa®, (generic name perampanel) for use in adjunctive treatment of partial onset seizures (with or without secondarily generalized seizures) in epilepsy patients 12 years of age and older.

In China, it is estimated that there are approximately 9 million patients with epilepsy, approximately 60% of whom are affected by partial-onset seizures. About 40% patients with partial-onset seizures require adjunctive treatment1. As approximately 30% of patients with epilepsy are unable to control their seizures with currently available AEDs2, this is a disease with significant unmet medical needs. Fycompa was designated for Priority Review by the National Medical Products Administration due to its significant clinical benefits compared to existing treatments after the submission in September 2018 and was approved on September 29, 2019.

Fycompa is a first-in-class AED and a once-daily tablet discovered at Eisai’s Tsukuba Research Laboratories. In the United States and Europe, a new oral suspension formulation has been approved and is being marketed. The agent is a highly selective, noncompetitive AMPA receptor antagonist that reduces neuronal hyperexcitation associated with seizures by targeting glutamate activity at AMPA receptors on postsynaptic membranes.

Fycompa has been approved in over 65 countries around the world as an adjunctive treatment for partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 12 years of age and older. In addition, Fycompa has been approved in over 60 countries as an adjunctive treatment for primary generalized tonic-clonic seizures in patients with epilepsy 12 years of age and older. In the United States, Fycompa is also indicated for monotherapy and adjunctive use in the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 4 years of age and older.

Eisai considers neurology including epilepsy, a therapeutic area of focus. With this launch of Fycompa in China, Eisai pursues our mission to provide “seizure freedom” to a greater number of patients with epilepsy across the world. Eisai seeks to address the diverse needs of, as well as increasing the benefits provided to, patients with epilepsy and their families.

Valproate, Sexual Health, and Men: A Narrative Review

OBJECTIVE: This article explores current evidence about the effects of valproate (VPA) medicines on sexual health in men, how to monitor symptoms, communicate with patients, and improve clinical outcomes. There has been a lot of focus on VPA use in women of childbearing age following recent changes to prescribing regulations owing to the well-established and significant teratogenic risk. Concerns have been raised by patients and clinicians as to the risk of adverse sexual effects of VPA use in men.

RESULTS: The evidence base for the effect of VPA on sexual function compared with other antiepileptic drugs (AEDs) in men is limited with no randomized controlled trials. Sexual function in men with epilepsy is complex, and there is no direct relationship between objective measures of sexual function and sexual satisfaction. Epilepsy, comorbidities, psychosocial factors, and most AEDs including VPA may cause sexual dysfunction in men, including reduced sexual desire, erectile dysfunction, and fertility problems. Sexual and reproductive function should be discussed with men prior to treatment with AEDs including VPA.

CONCLUSION: Early and proactive discussion of sexual and reproductive functioning mitigates, rather than increases, the risk of sexual problems and potentially improves adherence. Sexual dysfunction in men with cognitive impairment [such as intellectual disability (ID) and dementia] may present with behavioral disturbance. Identification of sexual adverse effects of medication could significantly change treatment plans which is of particular importance for individuals with treatment resistance. The research team provides an information fact sheet for men to help guide prescribing discussions.

Open-label, Uncontrolled Retrospective Study Provides Eevidence that Perampanel (Fycompa) May Help in Adults with Lennox-Gastaut Syndrome

Purpose: Perampanel (PER) was added to the anticonvulsant regimen of 71 patients with Lennox-Gastaut Syndrome (LGS) to evaluate its efficacy against seizures and its tolerability.

Method: This team evaluated at 3 month intervals 62 with pure LGS and 9 with LGS-like epileptic encephalopathy (28 females, 43 males, mean age 40.1 ± 11.5 yrs, median 38, range 20–71) in whom PER was introduced by 2 mg steps at 2- to 4-week intervals up to 6 mg/day, with possible dose reduction or increases after that. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed.

Results: Mean PER exposure was 538.9 days ± 425 (median 429), with 44 patients (62%) on PER at last follow-up. About 2/3 of patients were responders, including 35.2% that had a at least a 75% decrease in their seizures. Among these 16.9% had a 90% or greater decrease. No improvement was seen in 14 patients; 5 had a less than 50 % response, and 6 had seizure aggravation. Therefore, 25 (35.2%) were considered non-responders. Half of the patients developed at least one side-effect. Significant negative changes in behavior were noted in 1/3 of the cases, including irritability (8.5%) and aggressivity (7%). In contrast, 4 patients reported positive behavioral and psychological well-being side-effects.

Conclusions: This retrospective, open-label study provides evidence that perampanel (PER) may significantly help in Lennox-Gastaut syndrome (LGS). PER should be tried in LGS patients who are not satisfactorily controlled. Its use may be limited in some patients due to behavioral side-effects occurring, particularly at doses at or above 6 mg/d.