Tolerability and efficacy of perampanel in children with refractory epilepsy.

AIM: There are few reports on the tolerability and efficacy of perampanel, a new antiepileptic drug with a novel mechanism of action, in children and adolescents. We aimed to describe our experience with perampanel add-on and mono-therapy in children with refractory epilepsy. METHOD: Computerized medical records of children treated with perampanel in the paediatric neurology clinic from December 2012 to October 2015 were reviewed. RESULTS: Twenty-four children treated with perampanel (15 females, 9 males) aged 1 year 6 months to 17 years (mean 10y, standard deviation [SD] 4y 5mo) were identified. Adverse events were more common in children aged 12 years or older (89%) compared to younger children (53%), and were mainly behavioural. Ten (42%) children had 50 per cent or higher seizure reduction, two (8%) children had 33 per cent seizure reduction, and seizures were less severe in one (4%) child. Perampanel was discontinued in 13 (54%) children mostly due to adverse events. The mean duration of follow-up in the remaining 11 children was 8.1 months (SD 5.2) (range 1.3-17mo). INTERPRETATION: Perampanel is associated with a relatively high rate of behavioural adverse events mostly in adolescents with refractory epilepsy.

Efficacy and safety of felbamate in children with refractory epilepsy.

BACKGROUND: Despite the introduction of multiple new antiepileptic drugs in the past two decades, many patients with epilepsy continue to experience uncontrolled seizures or significant side effects. AIM: To present our experience with felbamate therapy in children with drug-resistant epilepsy. METHODS: We retrospectively reviewed the medical charts and video-EEG recordings of all patients receiving felbamate until May 2012. Efficacy was determined according to seizure frequency during the week prior to treatment initiation and the week after the maximal dosage of felbamate was reached. RESULTS: Fifty patients (34 boys) aged 4 months to 17 years (mean--5.5 years) were identified. Nearly third of the patients had Lennox-Gastaut syndrome. Mean epilepsy duration was 3.4 years (range--1 month to 13 years). The mean number of previous antiepileptic drugs was 7.5. The mean duration of follow-up was 1.1 years. Seizure frequency decreased by at least 50% in 29 (58%) patients. Side effects were reported in 22 (44%) patients, none of them included aplastic anemia or liver failure. In the responder group, the maximal dose of felbamate was lower and the patients were older compared to non-responders. CONCLUSIONS: Despite current recommendations, felbamate is initiated following multiple AEDs. Based on its efficacy and safety data, earlier initiation of felbamate is recommended in children with refractory epilepsy.

Preliminary efficacy and safety of lacosamide in children with refractory epilepsy.

BACKGROUND: Despite the introduction of multiple new antiepileptic drugs (AEDs) in the past 20 years, about 30% of patients with epilepsy continue to experience uncontrolled seizures or significant side effects. AIMS: To present our experience with lacosamide therapy in children with drug-resistant epilepsy. METHODS: We retrospectively reviewed the medical charts of all patients receiving oral lacosamide until October 2010. Efficacy was determined according to seizure frequency during the week prior to treatment initiation and the week after the maximal dosage of lacosamide was attained. RESULTS: Seventeen patients (10 boys) aged 1.5-16 (mean - 8 ± 4.7) years were identified. Nine patients had epilepsy attributed to a structural cause, six patients had epilepsy of unknown cause, and two had Lennox-Gastaut syndrome. Mean epilepsy duration was 5.4 ± 3.3 years. The mean number of previous AEDs was 6.6 ± 2. Lacosamide was added to the baseline AEDs in13 patients. The mean duration of follow-up was 9.1 ± 4.4 months. Six (35%) patients had at least a 50%.seizure reduction (mean - 76%). Social, behavioral, and/or motor improvement were noted in seven (41%) patients. Lacosamide was discontinued in six (35%) patients because of inefficacy. Side effects were reported in 10 (59%) patients. CONCLUSIONS: Lacosamide seems to be effective and safe according to the data in our small cohort. Further prospective studies on lacosamide efficacy and safety in a large number of children are warranted.