P41 – 2776: Efficacy and safety of perampanel as add-on treatment for focal refractory epilepsy in children with autism spectrum disorder

Abstract

Objective The purpose of the study was to evaluate the efficacy and safety of perampanel (PRP) as add-on antiepileptic therapy in children with autism spectrum disorder and refractory focal epilepsy. Methods This was a retrospective review of 5 consecutive autistic patients with refractory focal epilepsy who were exposed to PRP for at least six months. All patients were analyzed for changes in seizure frequency per month, seizure freedom and adverse events (AEs). We also evaluated retention rate of PRP at six months. Results Five patients were included. All of them were male. Mean age was 10.8 years (range 6–14 years). The mean initial dose of PRP was 1.8 mg per day (range: 1–2 mg). The dosage was increased at 2 to 3 weeks intervals by increments of 1 to 2 mg. The mean maintenance dose of PRP was 8.4 mg per day (range 6–12 mg). Mean follow-up duration was 10 months (range 8–12 months). All 5 patients had focal frontal lobe epilepsy. Four of the 5 patients (80%) showed a seizure reduction of >or=50%, including 3 patients (60%) who became seizure-free for at least 3 months. Four patients (80%) reported AEs. The leading AEs were irritability (80%), somnolence (60%), dizziness (40%) and aggression (20%). There was no withdrawal from PRP because of AEs. Improvement in attention and reactivity was observed in 80% of patients. PRP had a retention rate of 80% at 6 months. Conclusion PRP adjunctive therapy is effective and safe for autistic patients with refractory focal epilepsy and has a good retention rate. Tolerability was worse in patients with two or more base-line antiepileptic drugs. All patients with psychiatric AEs had a previous history of behavioural disorders and similar previous reactions to other drugs like levetiracetam, vigabatrin and zonisamide. These AEs improved when we slowed dose titration.