Year: 2024
Type: article
Study design: Observational Study
Abstract: Traditionally, the frequency of seizures reported by patients or relatives is used to measure response to ASM. 7 Nevertheless, patients are usually unaware of up to 60% of their seizures when they are awake and up to 80% of their seizures during sleep.8,9 In addition, patients might not be aware of epileptiform activity when they appear.10,11 Accordingly, the epileptiform discharge burden on EEG rather than the declared seizure frequency might be a more reliable measure of disease activity.[12][13][14][15][16][17] Given these factors, long-term EEG recordings that assess epileptiform discharge burden might provide a more objective indicator of prognosis and improvement after ASM initiation.[11][12][13][14][15][16][17][18] Perampanel (PER), a non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, receptor antagonist, received approval from the European Medicine Agency (EMA) for use as an adjunctive therapy for both focal and generalized epilepsy, and it has demonstrated efficacy in various off-label clinical scenarios, from myoclonic epilepsy to status epilepticus.[19][20][21][22] Among all available ASMs, PER is the sole medication that directly inhibits glutamatergic pathways.23 Little is described about the measurable effect of ASM on epileptiform discharge in focal and generalized epilepsy.Few studies have investigated the effects of newer ASMs.This study aimed to evaluate the effects of PER on EEG.24 Our results might provide a different Abstract Objective: Perampanel (PER), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist, has been approved as adjunctive therapy for focal and generalized epilepsy.Limited information is available regarding the measurable impact of anti-seizure medications (ASM).In this study, we aimed to investigate the effects of PER on electroencephalography (EEG) background activity and interictal epileptic discharge.Methods: This study included all patients with a clinical diagnosis of epilepsy who underwent routine EEG before and after PER treatment between 2018 and 2023.EEG findings were examined according to their background activity and clinical features such as risk factors of epilepsy, the occurrence of sleep-related seizures, sleep disorders, intellectual disability, abnormality of magnetic resonance imaging and EEG, multifocal features on EEG, the duration between EEG and initiation of PER treatment, frequency of seizures before and after PER treatment (seizure freedom or >50% reduction in seizures), previous epilepsy surgery, the number of current and previous ASM, and dosage of PER.Results: In a total of 11 patients, epilepsy type was focal in 8 (73%), all of the patients were on polytherapy, and 4 of them had undergone epilepsy surgery.PER treatment resulted in seizure freedom in 36% of patients and a >50% decrease in seizures in 55% of patients.There was no statistically significant relationship between background activity, phase reversal, and equipotential in EEG before and after PER treatment.In addition, pre-and posttreatment responses to activation procedures and disruption in sleep structure did not differ significantly.The relationship between seizure freedom and phase reversal decrease after PER treatment was statistically significant.The relationship between a >50% decrease in the frequency of seizures and epileptic discharges also reached statistical significance.Conclusion: To summarize, seizure freedom following PER treatment appears to be associated with reduced epileptic discharge, and EEG monitoring might help determine prognosis.
Source: Archives of Epilepsy
Authors: İrem Erkent, Candan Gürses
Institution: Koç University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4404415311