Perampanel and Visuospatial Skills in Children With Epilepsy.

Francesca Felicia Operto,Chiara Scuoppo,Giuseppe Quatrosi,Valentina Vivenzio,Grazia Maria Giovanna Pastorino,Michele Roccella,Chiara Padovano

doi:10.3389/fneur.2021.696946

Francesca Felicia Operto, Chiara Scuoppo + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2021.696946

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Abstract

Introduction: Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy. PER does not seem to negatively affect the cognitive profile in children and adolescents, but its influence on visuospatial abilities is still to be assessed. The aim of our study was to assess visuospatial skills through a standardized neuropsychological evaluation in adolescents taking PER for 12 months.Methods: Our sample included 46 adolescents aged 12–18 years with focal and generalized drug-resistant epilepsy already in therapy with one or two antiseizure medications. Changes in visuospatial perception and memory were assessed by the Rey–Osterrieth Complex Figure Test at baseline (before taking PER) and after 12 months of pharmacological treatment. Executive functions and non-verbal intelligence were also assessed at baseline.Results: After 12 months of PER therapy, the mean scores on the Rey–Osterrieth Complex Figure Test remained almost unchanged for both visuospatial perception and visuospatial memory skills. At baseline, visuospatial memory was related to executive function, and visuospatial perception was related to executive function and non-verbal intelligence.Conclusions: Adjunctive treatment with PER did not negatively affect visuospatial skills. No adverse event effects have been reported after 12 months of follow-up, and this suggests a good tolerability in the middle-to-long term.

Highlights

Perampanel (PER) is a non-competitive amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy
Its peculiarity consists of a novel mechanism of action, different from other antiseizure medication (ASM): PER is a selective, non-competitive antagonist to the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, an ionotropic glutamate receptor, that plays a basic part in fast excitatory synaptic transmission [4]
There were no significant differences between the main sample characteristics at baseline and T1

Summary

Introduction

Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy. PER does not seem to negatively affect the cognitive profile in children and adolescents, but its influence on visuospatial abilities is still to be assessed. Perampanel (PER) is a relatively new antiseizure medication (ASM), approved as an additional treatment for focal-onset seizures with or without loss of awareness and primary generalized seizures in epileptic patients aged 4 years and older [1,2,3]. A subsequent multicenter, randomized, placebo-controlled study showed its efficacy in primary generalized tonic-clonic seizures in 164 patients aged 12 years and older [10]. The most common AEs reported were dizziness (20.4%), drowsiness (15.3%), aggression (8.2%), decreased appetite (6.1%), and rhinitis (5.1%). It appears that the incidence of AEs is lower with a slower titration rate and that the AEs are reversible with the discontinuation of PER or with a dose adjustment [13]

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