Abstract
Background. Despite the existing variety of available methods for the treatment of drug-resistant epilepsy in children, there are still many patients that are not suitable for surgical treatment and have no response to alternative therapeutic measures (vagus nerve stimulation and ketogenic diet). In these patients, the problem of searching for new antiepileptic drugs is particularly urgent. The article presents original data on the efficacy and tolerability of perampanel in children with epilepsy. Materials and methods . Our retrospective study included 55 children (33 males and 22 females) under the age of 18 that received perampanel. This study was performed without external sponsor support at the Svt. Luka’s Institute of Child Neurology and Epilepsy during 2015–2017. Results . Perampanel demonstrated high efficiency against generalized (myoclonic and tonic) seizures and moderate efficiency against focal motor seizures. The drug was significantly less effective in patients with atypical absence seizures and ineffective in children with atonic seizures. Perampanel was generally well tolerated by the majority of patients. The most frequent adverse effects that required the drug to be withdrawn (9 out of 55 cases, 16.4 %) were psychic exhaustion and apathy. Less frequent side effects that lead to perampanel cessation included aggravation (4 %), psychotic episode (2 %) and idiosyncrasy (2 %). Such transient states as ataxia (21 %), decreased appetite (13 %) and muscle rela xation (24.5 %) did not require perampanel withdrawal. Our results suggest that the efficacy of perampanel is 58.5 %. Currently, 37.8 % of patients continue receiving the drug, whereas in 20.7 % of children it was withdrawn due to adverse reactions, despite its high efficacy against seizures. In 41.5 % of patients, we observed neither positive effect nor adverse reactions. Conclusions . Further studies on perampanel in children under 12 years old are needed, since our results suggest its efficiency for drug-resistant epilepsy.
Highlights
Despite the existing variety of available methods for the treatment of drug-resistant epilepsy in children, there are still many patients that are not suitable for surgical treatment and have no response to alternative therapeutic measures
Perampanel was generally well tolerated by the majority of patients
Less frequent side effects that lead to perampanel cessation included aggravation (4 %), psychotic episode (2 %) and idiosyncrasy (2 %)
Summary
Возможности применения перампанела в лечении фармакорезистентных форм эпилепсии у детей. Несмотря на широкие возможности современных медикаментозных и немедикаментозных методов лечения фармакорезистентных форм эпилепсии у детей, остается значительная часть пациентов с устойчивой к лечению эпилепсией, у которых оперативное лечение невозможно и альтернативные методы лечения (стимуляция блуждающего нерва и кетогенная диета) неэффективны. Отмечены высокая эффективность перампанела в отношении генерализованных (миоклонических и тонических) приступов у детей и средняя степень эффективности в отношении фокальных моторных приступов; препарат был малоэффективен при атипичных абсансах и неэффективен в отношении атонических приступов. У 20,7 % пациентов с хорошим терапевтическим эффектом перампанел был отменен в связи с развитием нежелательных явлений. Необходимы дальнейшие исследования перампанела у детей в возрасте до 12 лет в связи с полученными данными об эффективности препарата в отношении эпилептических приступов при фармакорезистентных формах эпилепсии.
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