ICNC Abstracts, ICNC 2018

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Perampanel and Brivaracetam: Efficacy and safety in pediatric refractory epilepsy
Divya Subramanian Khurana, Ana Melikishvili, Sara McGuire, Karen S Carvalho, Ignacio Valencia, Daphne M Hasbani, Uzma Sharif, Agustin Legido

Last modified: 2018-09-09

Abstract


Brivaracetam and peramapanel are newer antiepileptic drugs (AEDS) approved as monotherapy for focal seizures. Perampanel is also approved as adjunctive treatment for primary generalized tonic clonic seizures. Brivaracetam displays a high affinity for the synaptic vesicle protein 2 (SV2A) in the brain; Perampanel hydrate is a first-in-class α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) post-synaptic receptor selective non-competitive antagonist.  Both have novel mechanisms of action but real-world clinical data, especially in children are sparse. We retrospectively reviewed children with refractory epilepsy treated at our institution from 2013-2018. Twenty patients treated with brivaracetam and 19 patients treated with perampanel were identified.  Age ranged 4-20 years. Of the patients treated with brivaracetam, 11 (55%) had focal epilepsy, 6 (30%) generalized epilepsy and 3 (15 %) mixed. Of the perampanel treated patients, 7 (37%) had focal epilepsy, 11 (58 %) generalized epilepsy and  1 ( 5%) mixed.   Eight patients (40 %) in the brivaracetam treated group and 7 ( 37 %) in the perampanel treated group had seizure reduction greater than 50%. The majority of responders 7/8 (87.5%) in the brivarecetam group had focal epilepsy,  4/7 (57%) responders in the perampanel group had generalized epilepsy. Most frequent side effects noted with brivaracetam were drowsiness in two patients and worsening behavior in 3 while the perampanel group reported sedation in 4 and behavior changes in  5. The most frequent cause for therapy discontinuation in both groups was lack of efficacy. In conclusion, both of these newer AEDs are effective in the adjunctive treatment of refractory pediatric epilepsy.


Keywords


Epilepsy; antiepileptic drugs

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