Permampenel in Refractory Epilepsy - Investigator initiated study

1. To estimate the efficacy and tolerability of Perampanel in children and adolescents 6 mo-18yrs with pharmacoresistant eplepsy 2. Materials and methods: A Retro prospective investigator initiated Observational cohort study was done in the year 2020 Responder rate defined as number of patients whose seizure frequency in last three months reduced by ≥50%. Results - 25/176 children and adolescents aged ≤18 years with pharmaco- resistant epilepsy were excluded. 151 had complete data from ≥3 months follow-up. Age 7months to 278 months (mean 72.5±54.3 months) Median age at onset of seizures 6 months (1-16 months). Mean duration of epilepsy before Perampanel initiation 28 months Median seizure frequency per month before PER initiation was 120 (30-300) and mean number of antiseizure drugs before PER 4.05±1.5. Perampanel was the second add on drug in 16 patients (10.6%), third add 39 (25.8%), and fourth add on (28.5%).Retention rates were 135(89.4%) and 114 (75.4%) who remained on PER at 3 and 6 months Overall 50% reduction in 27/135(20%) at three months follow up to 19/114(16.6%) at six months. > 75% seizure reduction 41/135 (30.3%) to 37/114 (32.4%) at 3 and 6 months. Near complete seizure control (increased from 24/135 (17.7%) at three and 32/114 (28.0%) at six months. Adverse neurological events excessive sleepiness in 24 (15.9%), psychiatric manifestations 14 (9.3%). skin rash 4 (2.6%), weight gain 5 (3.3%) Conclusion -Perampanel is good add on across epilepsy spectrum. Early add on of Perampanel showed better efficacy. Adverse events can be minimized by starting at low dose.