Feeding regimes affected the circadian rhythms of pancreatic digestive enzymes and somatic growth in flathead grey mullet (Mugil cephalus) fry.

The effect of different feeding regimes on the circadian rhythms of pancreatic digestive enzyme activities was evaluated in Mugil cephalus fry weighting 0.34 ± 0.01 g. Feeding regimes (feeding ration = 3% stocked biomass) differed on the number of meals offered per day: one, two and ten meals per day (R1, R2 and R3, respectively). The number of meals per day affected somatic growth; in particular, fry from the R3 group (0.80 ± 0.01 g) grew better than their congeners from R2 (0.70 ± 0.01 g) and R1 (0.63 ± 0.01 g) groups (P < 0.05). Feeding behaviour was modulated by the feeding regime, being the maximal gut fullness values found just after meal distribution in R1 and R2 groups, whereas this trend was not observed when feed was offered continuously during light hours (R3). Fry from R1 and R2 groups showed hyperphagia as they tended to store in their gut as much as possible feed particles to be later digested due to the limited daily meals. This strategy negatively affected feed digestion due to inappropriate enzyme to substrate ratio, changes in digestive enzyme activities and chyme transit times, which ultimately impaired growth performance. Enzyme activities were modulated by the number of meals, the more frequent the meals offered, the lower enzyme activities, supporting the hypothesis that digestive function is adapted to obtain a maximum benefit of the ingested nutrients. Present results showed that feeding grey mullet fry continuously during day light hours optimized feed digestion and promoted fry growth.

Ontogeny of the digestive tract in stinging catfish, Heteropneustes fossilis (Bloch) larvae.

Heteropneustes fossilis (Bloch) is an important candidate species for diversification of freshwater aquaculture in India. However, high mortality rate during larval rearing is the most serious bottleneck in commercial production of this species. A proper understanding of the ontogenic development of digestive system provides the basis to understand the nutritional physiology of larvae and develop appropriate feeding strategies. In the present study, the ontogenical development of the digestive tract in H. fossilis larvae was studied from hatching until 30 day post-hatching (dph) at 29 °C. At hatching (2.8 ± 0.2 mm standard length, SL), the digestive tract was undifferentiated and attached dorsally to the yolk sac. At 1 dph (2.9 ± 0.2 mm SL), the mouth opened and oral valves were visible. At 2 dph (3.0 ± 0.3 mm SL), goblet cells were observed in the buccoparyngaeal cavity. At this age, exogenous feeding started and the intestine was differentiated into the anterior and posterior regions, and the rudimentary liver and pancreas were also seen. Small supranuclear vacuoles were observed in the enterocytes of the posterior intestine at 2 dph. Zymogen granules were observed in acinar cells of pancreas by 3 dph, and islets of Langerhans were visible at 4 dph (3.5 ± 0.1 mm SL). At the same age, most of the yolk sac reserves were consumed, whereas they were completely exhausted by 5 dph (3.9 ± 0.5 mm SL). Between 4 and 6 dph, the liver elongated in size and started to accumulate lipids in the hepatocytes. Gastric glands were detected at 4 dph, and the pyloric sphincter was completely differentiated at 9 dph (6.1 ± 0.4 mm SL) as an epithelial fold that separated stomach from the anterior intestine. By 13 dph (8.6 ± 0.2 mm SL), profuse gastric glands were visible inside longitudinal mucosal folds of the stomach. The formation of gastric glands and their development were noticed as the last events in the development of the digestive tract in H. fossilis. This indicated the end of the larval period and the commencement of the juvenile stage. Considering these observations, it is suggested that H. fossilis larvae have a morphologically complete digestive tract by 13 dph. The findings of the study on the development of the digestive system in H. fossilis may help in synchronising the larval stage of development and feeding strategies and would be helpful in improving larval rearing techniques for catfish species.

Skeletogenesis in the Persian sturgeon Acipenser persicus and its correlation with gene expression of vitamin K-dependent proteins during larval development.

The present study describes morphological development of the skeleton in the Persian sturgeon Acipenser persicus and discusses the hypothesis that expression of genes encoding vitamin K-dependent proteins (VKDP) might be correlated with the mineralization of skeletal tissues during early development in sturgeons. Results showed that development of cartilage started just after hatching (mean ± S.D., 10·9 ± 0·7 mm in total length, LT ) in the head and notochord, whereas the first signs of mineralization occurred in the dentary and in the dermopalatine and palatopterygoid elements of the upper jaw, coinciding with the onset of exogenous feeding (20·1 ± 1·5 mm LT ). All branchial arch elements developed between 19·3 and 22·3 mm LT , whereas mineralization was only observed in tooth plates associated with the hypobranchial 1 and gill rakers at 20·8 ± 1·5 mm LT and 48·4 ± 6·4 mm LT , respectively. Quantitative real-time PCR showed that transcripts of VKDP genes including bone Gla protein (bgp), matrix Gla protein (mgp) and Gla rich protein (grp) genes were significantly up-regulated during the transition to exogenous feeding, supporting hypotheses about relevance of the above-mentioned genes in chondrogenesis at early developmental stages. The strong mineralization of skeletal elements from 21·5 to 27·3 mm LT (20 days post hatch) was in accordance with the maximal levels of bgp, mgp and grp expression indicating a correlation between development of the skeleton and the expression of VKDP genes. These data are important for evaluating A. persicus larval quality, understanding the influence of rearing biotic and abiotic factors on skeletogenesis and recognizing the occurrence of skeletal deformities in this species.

Ontogeny changes and weaning effects in gene expression patterns of digestive enzymes and regulatory digestive factors in spotted rose snapper (Lutjanus guttatus) larvae.

The study of digestive physiology is an important issue in species that have been introduced in aquaculture like the spotted rose snapper (Lutjanus guttatus). The aims of this study were to describe the expression of digestive enzymes (trypsinogen, chymotrypsinogen, α-amylase, lipoprotein lipase, phospholipase A and pepsinogen) and their relation with orexigenic (neuropeptide Y, NPY) and anorexigenic (cholecystokinin, CCK) factors during the larval development and to evaluate the effect of weaning in their expression. The results showed that the transcripts of all the assayed digestive enzymes, with the exception of pepsinogen, and NPY and CCK were already present in L. guttatus from the hatching stage. The expression of all the enzymes was low during the yolk-sac stage (0-2 days after hatching, DAH), whereas after the onset of exogenous feeding at 2 DAH, their expression increased and fluctuated throughout larval development, which followed a similar pattern as in other marine fish species and reflected changes in different types of food items and the progressive maturation of the digestive system. On the other hand, weaning of L. guttatus larvae from live prey onto a microdiet between 25 and 35 DAH significantly affected the relative expression of most pancreatic digestive enzymes during the first weaning days, whereas chymotrypsinogen 2 and lipoprotein lipase remained stable during this period. At the end of co-feeding, larvae showed similar levels of gene expression regardless of the diet (live prey vs. microdiet), which indicated that larvae of L. guttatus were able to adapt their digestive capacities to the microdiet. In contrast, feeding L. guttatus larvae with live feed or microdiet did not affect the expression of CCK and NPY. The relevance of these findings with regard to current larval rearing procedures of L. guttatus is discussed.

Development of digestive tract and enzyme activities during the early ontogeny of the tropical gar Atractosteus tropicus.

Changes in digestive enzyme activity and histology were studied in Atractosteus tropicus embryos, larvae and juvenile periods. Alkaline protease, chymotrypsin, carboxypeptidase A, lipase and α-amylase were detected in all periods and gradually increased until reaching the maximum peak in juveniles; meanwhile, acid protease was first detected at 5 days after hatching (dah) when first feeding started and trypsin and leucine aminopeptidase activities were detected from 19 dah, their values being increased gradually until reaching a maximum value at 31 dah. Acid and alkaline phosphatase activities increased from yolk-sac absorption (3 dah) until day 31 after hatching. Zymogram for acid protease showed two bands in active forms (0.4 and 0.5 Rfs) from day 5 after hatching and a third protease form (0.3 Rf) that appears at 31 dah. Two active forms (26.3 and 24.9 kDa) were detected using SDS-PAGE alkaline proteases zymogram at 5 dah, and an additional active form (44.1 kDa) was detected at 7 dah. Regarding the histological development of the digestive system, the exocrine pancreas containing zymogen granules was already visible at 3 dah, whereas at 5 dah first gastric glands were already detected in the stomach. Between 7 and 9 dah, the digestive tract of A. tropicus resembled that of a juvenile specimen with a well-developed and short oesophagus, stomach divided into a glandular and non-glandular (pyloric) stomach, folded intestine with pyloric caeca and a well-developed spiral valve (posterior intestine). Considering this, larvae of A. tropicus are capable of digesting several foods from yolk absorption (3 dah), maximizing its activities at 15 dah, age at which the organisms maximize its capability to absorb nutrients from diets provided.

Feeding habits and ontogenic changes in digestive enzyme patterns in five freshwater teleosts.

Feeding habits and the activity of digestive enzymes (total alkaline proteases, α-amylase and lipase) from dace Leuciscus leuciscus, roach Rutilus rutilus, Prussian carp Carassius auratus gibelio, perch Perca fluviatilis and pikeperch Sander lucioperca fry were studied in the Malye Chany Lake-Kargat Estuary (western Siberia, Russia). The diet of fry from all studied species was mainly composed of chironomid larvae and zooplanktonic organisms (i.e. cladocera and copepoda), whereas carnivorous species such as P. fluviatilis and S. lucioperca also preyed on fry from other fishes while detritus and microalgae were also important in the diet of ommivorous species. When comparing diet similarity (Sørensen-Dice index, Q(S)) among fry at different stages of development, both omnivorous and carnivorous species showed a high level of similarity (0.67 < Q(S) < 0.89 and 0.73 < Q(S)< 0.89, respectively). Diet similarity values were in agreement with the overall digestive activity profile analysed by cluster analysis. Diet similarity suggested potential trophic competition when zooplanktonic and benthic prey began to decline towards autumn. The analysis of pancreatic digestive enzymes revealed a correlation among their activities and fry feeding habits with α-amylase:total proteases (A:P) values higher than 1 in omnivorous species and lower (A:P ≤ 1) in carnivorous species.

Partial characterisation of digestive proteases of the Mayan cichlid Cichlasoma urophthalmus.

The characterisation of digestive proteases in native freshwater fish such as the Mayan cichlid Cichlasoma urophthalmus provides scientific elements that may be used to design balanced feed that matches with the digestive capacity of the fish. The purpose of this study was to characterise the digestive proteases, including the effect of the pH and the temperature on enzyme activity and stability, as well as the effect of inhibitors using multienzymatic extracts of the stomach and intestine of C. urophthalmus juveniles. Results showed that the optimum activities of the acid and alkaline proteases occurred at pH values of 3 and 9, respectively, whereas their optimum temperatures were 55 and 65 °C, respectively. The acid proteases were most stable at pH values of 2­3 and at temperatures of 35­45 °C, whereas the alkaline proteases were most stable at pH values of 6­9 and at 25­55 °C. The inhibition assays recorded a residual activity of 4% with pepstatin A for the acid proteases. The inhibition of the alkaline proteases was greater than 80% with TPCK, TLCK, EDTA and ovalbumin, and of 60 and 43.8% with PMSF and SBT1, respectively. The results obtained in this study make it possible to state that C. urophthalmus has a sufficiently complete digestive enzyme machinery to degrade food items characteristic of an omnivorous fish species, although specimens showed a tendency to carnivory.

Comparative analysis of a teleost skeleton transcriptome provides insight into its regulation.

An articulated endoskeleton that is calcified is a unifying innovation of the vertebrates, however the molecular basis of the structural divergence between terrestrial and aquatic vertebrates, such as teleost fish, has not been determined. In the present study long-read next generation sequencing (NGS, Roche 454 platform) was used to characterize acellular perichondral bone (vertebrae) and chondroid bone (gill arch) in the gilthead sea bream (Sparus auratus). A total of 15.97 and 14.53Mb were produced, respectively from vertebrae and gill arch cDNA libraries and yielded 32,374 and 28,371 contigs (consensus sequences) respectively. 10,455 contigs from vertebrae and 10,625 contigs from gill arches were annotated with gene ontology terms. Comparative analysis of the global transcriptome revealed 4249 unique transcripts in vertebrae, 4201 unique transcripts in the gill arches and 3700 common transcripts. Several core gene networks were conserved between the gilthead sea bream and mammalian skeleton. Transcripts for putative endocrine factors were identified in acellular gilthead sea bream bone suggesting that in common with mammalian bone it can act as an endocrine tissue. The acellular bone of the vertebra, in contrast to current opinion based on histological analysis, was responsive to a short fast and significant (p<0.05) down-regulation of several transcripts identified by NGS, osteonectin, osteocalcin, cathepsin K and IGFI occurred. In gill arches fasting caused a significant (p<0.05) down-regulation of osteocalcin and up-regulation of MMP9.

Co-infection with Pseudomonas anguilliseptica and Delftia acidovorans in the European eel, Anguilla anguilla (L.): a case history of an illegally trafficked protected species.

Inspections by customs agents at Barcelona airport discovered 420 kg of contraband glass eels prepared for shipment to Hong Kong. After confiscation of these animals by police, they were transported to holding facilities to be maintained until after a judicial hearing. Upon arrival, they were separated into two groups and held under ambient flow-through conditions in fresh water. During their captivity period, several peaks in mortality occurred and multiple bacterial strains were isolated from moribund animals. Sequencing of 16S rDNA was used to determine specific identity of the isolates. An initial isolation of Pseudomonas anguilliseptica was treated with oxytetracycline. A subsequent isolation of Delftia acidovorans proved resistant to oxytetracycline and was treated with gentamicin in combination with sulphadiazine-trimethoprim. Once the health condition of the animals was stabilized, they were partitioned into groups and subsequently released as part of a restocking effort for the species following the guidelines of Regulation (EC) 1100/2007 (Anon 2007). This represents the first record for both bacterial species in the host Anguilla anguilla in the Spanish Mediterranean.

High dietary arachidonic acid levels affect the process of eye migration and head shape in pseudoalbino Senegalese sole Solea senegalensis early juveniles.

The effect of high dietary levels of arachidonic acid (ARA) on the eye migration and cranial bone remodelling processes in Senegalese sole Solea senegalensis early juveniles (age: 50 days post hatch) was evaluated by means of geometric morphometric analysis and alizarin red staining of cranial skeletal elements. The incidence of normally pigmented fish fed the control diet was 99·1 ± 0·3% (mean ± s.e.), whereas it was only 18·7 ± 7·5% for those fed high levels of ARA (ARA-H). The frequency of cranial deformities was significantly higher in fish fed ARA-H (95·1 ± 1·5%) than in those fed the control diet (1·9 ± 1·9%). Cranial deformities were significantly and negatively correlated with the incidence of normally pigmented animals (r² = -0·88, P < 0·001, n = 16). Thus, fish displaying pigmentary disorders differed in the position of their eyes with regard to the vertebral column and mouth axes, and by the interocular distance and head height, which were shorter than in fish not displaying pigmentary disorders. In addition to changes in the positioning of both eyes, pseudoalbino fish showed some ARA-induced osteological differences for some of the skeletal elements from the splanchnocranium (e.g. right premaxillary, dentary, angular, lacrimal, ceratohyal and branchiostegal rays) and neurocranium (e.g. sphenotic, left lateral ethmoid and left frontal) by comparison to normally pigmented specimens. Pseudoalbino fish also had teeth in both lower and upper jaws. This is the first study in Pleuronectiformes that describes impaired metamorphic relocation of the ocular side eye, the right eye in the case of S. senegalensis, whereas the left eye migrated into the ocular side almost normally.

Ontogeny of the digestive tract in butter catfish Ompok bimaculatus (Bloch) larvae.

The ontogeny of the digestive tract was studied histologically in butter catfish Ompok bimaculatus from hatching to 30 days post-hatching (dph). At hatching, the digestive tract of butter catfish consisted of a straight tube with a smooth lumen dorsally attached to the yolk sac. Between 1 and 2 dph, the mouth opened, oral valves were visible and canine-like teeth and taste buds were detected. During this period, intestine was differentiated into the anterior and posterior intestine, and the digestive accessory glands were also developed. Exogenous feeding started at 2 dph, and there was a 2-day mixed endogenous-exogenous feeding period. Most of the yolk sac reserves were consumed between 2 and 3 dph, and by 5 dph, the yolk sac was completely depleted and no longer visible in histological sections. Between 3 and 4 dph, several vacuoles (neutral lipids) were observed in the intestine and also in hepatocytes, indicating a functional absorption of nutrients from food. At 8 dph, differentiation of gastric glands was noticed, and by 9-11 dph, there were abundant gastric tubular glands arranged along numerous longitudinal folds. During the same period, pyloric sphincter appeared as an epithelial fold that separated the stomach from the anterior intestine. From 12 dph to the end of the study at 30 dph, no noticeable histological modifications were observed. The development of gastric glands is considered as the last major events in digestive tract development and their presence designates the end of larval period and the onset of the juvenile period. Hence, it is suggested that, butter catfish larvae have a morphologically complete digestive tract by 12 dph. These findings on the development of the digestive system in butter catfish may lead to a better understanding of the ontogeny and would be useful to improve the larval rearing techniques of this promising catfish species for freshwater aquaculture diversification.

Digestive enzyme activities during early ontogeny in Common snook (Centropomus undecimalis).

Common snook (Centropomus undecimalis) is one of the most important marine species under commercial exploitation in the Gulf of Mexico; for this reason, interest in developing its culture is a priority. However, larviculture remains as the main bottleneck for massive production. In this sense, our objective was to determine the changes of digestive enzymes activities using biochemical and electrophoretic techniques during 36 days of Common snook larviculture fed with live preys (microalgae, rotifers, and Artemia). During larviculture, all digestive enzymatic activities were detected with low values since yolk absorption, 2 days after hatching (dah) onwards. However, the maximum values for alkaline protease (6,500 U mg protein(-1)), trypsin (0.053 mU × 10(-3) mg protein(-1)), and Leucine aminopeptidase (1.4 × 10(-3) mU mg protein(-1)) were detected at 12 dah; for chymotrypsin at 25 dah (3.8 × 10(-3) mU mg protein(-1)), for carboxypeptidase A (280 mU mg protein(-1)) and lipase at 36 dah (480 U mg protein(-1)), for α-amylase at 7 dah (1.5 U mg protein(-1)), for acid phosphatases at 34 dah (5.5 U mg protein(-1)), and finally for alkaline phosphatase at 25 dah (70 U mg protein(-1)). The alkaline protease zymogram showed two active bands, the first (26.3 kDa) at 25 dah onwards, and the second (51.6 kDa) at 36 dah. The acid protease zymogram showed two bands (RF = 0.32 and 0.51, respectively) at 34 dah. The digestive enzymatic ontogeny of C. undecimalis is very similar to other strictly marine carnivorous fish, and we suggest that weaning process should be started at 34 dah.

Prolonged feed deprivation does not permanently compromise digestive function in migrating European glass eels Anguilla anguilla.

The effects of prolonged feed deprivation (40 days at 18° C) and re-feeding (30 days) on body mass, growth and the activity of selected pancreatic and intestinal enzymes were evaluated in migrating European glass eels Anguilla anguilla by comparison with a control group fed to satiation with hake Merluccius merluccius roe for the duration of the experiment. Feed deprivation resulted in mass loss and a reduction in digestive function, as revealed by a decrease in the total and specific activities of pancreatic (trypsin and α-amylase) and intestinal brush border (alkaline phosphatase and leucine aminopeptidase) enzymes. The total activity of intestinal brush border enzymes diminished after 5 days of feed deprivation, whereas that of pancreatic enzymes did not decrease until 10 days, indicating that the intestine is more sensitive to feed deprivation than the pancreas. Re-feeding A. anguilla that were starved for 40 days resulted in compensatory growth, with specific growth rates that were 2·6 times higher than the control group. This compensatory growth was associated with the recovery of trypsin and intestinal brush border enzyme activities, which were restored to control levels within 5 days of re-feeding. The ability to maintain pancreatic enzyme activity during 40 days of feed deprivation, and rapidly recover capacity for protein digestion upon re-feeding, would enable A. anguilla at this glass eel stage to withstand periods without food but rapidly provide amino acids for protein synthesis and growth when suitable food was available.

Morphological and histological study of larval development of the Senegal sole Solea senegalensis: an integrative study.

This study provides a comprehensive description of the main morphological and histological events that take place during larval and post-larval development of Senegal sole Solea senegalensis in order to establish a reference for its normal developmental organogenesis. Five stages have been described. Before gill development at the onset of metamorphosis (eye migration process, stage 4c), the skin was the main site of gas and ion exchange, whereas during stages 3 and 4, the skin begins differentiating into the definitive juvenile structure. The timing of development of the endocrine system depends on each organ, the endocrine pancreas and thyroid gland being the first to differentiate (stages 2 and 3, respectively), followed by the interrenal tissue and stannius corpuscles that develop at metamorphosis (stages 4 and 4c, respectively). The differentiation and maturation of the lymphohaematopoietic organs was coupled with the increase in complexity of the cardiovascular system and the presence of mature erythrocytes (stage 4b), which might be attributed to the change in respiration and the development of fully functional gills. In the differentiation of sensory structures, the development of eyes, inner ear, neuromasts and olfactory organs was rapid, with most of these organs becoming fully developed soon after hatching (stage 1). Vision, chemo- and mechano-reception developed very early in ontogeny, in parallel with the development of the central nervous system and changes in feeding habits. Although the general pattern of development in S. senegalensis appeared similar to most marine fish larvae already described, there were species-specific ontogenetic characteristics probably derived from the species' particular environment (subtropical waters) and behaviour (nocturnal, benthic, omnivorous feeding habits). These results on the organogenesis of larvae are a useful tool for establishing the functional systemic capabilities and physiological requirements of larvae to ensure optimal welfare and growth under aquaculture conditions.

Development of digestive enzymes in larvae of Mayan cichlid Cichlasoma urophthalmus.

The development of digestive enzymes during the early ontogeny of the Mayan cichlid (Cichlasoma urophthalmus) was studied using biochemical and electrophoretic techniques. From yolk absorption (6 days after hatching: dah), larvae were fed Artemia nauplii until 15 dah, afterward they were fed with commercial microparticulated trout food (45% protein and 16% lipids) from 16 to 60 dah. Several samples were collected including yolk-sac larvae (considered as day 1 after hatching) and specimens up to 60 dah. Most digestive enzymes were present from yolk absorption (5-6 dah), except for the specific acid proteases activity (pepsin-like), which increase rapidly from 8 dah up to 20 dah. Three alkaline proteases isoforms (24.0, 24.8, 84.5 kDa) were detected at 8 dah using SDS-PAGE zymogram, corresponding to trypsin, chymotrypsin and probably leucine aminopeptidase enzymes, and only one isoform was detected (relative electromobility, Rf = 0.54) for acid proteases (pepsin-like) from 3 dah onwards using PAGE zymogram. We concluded that C. urophthamus is a precocious fish with a great capacity to digest all kinds of food items, including artificial diets provided from 13 dah.

Perampanel in chronic insomnia.

OBJECTIVES: Insomnia is the most prevalent sleep disorder in the general population, and one of the most frequent reasons for consultation in the Sleep Units. Perampanel is an antiepileptic also effective on the structure of sleep, and in restless legs syndrome. We describe the first study that evaluates perampanel in patients with chronic insomnia. PATIENTS AND METHODS: Observational retrospective cohorts study of 66 patients with chronic resistant insomnia, 33 exposed to perampanel, other 33 as non-exposed group. All patients attended in Neurology or Psychiatry Consultation, from November 2017 to November 2018. Patients included had been treated with more than 4 different drugs in the previous 4 years. We reviewed age, sex, insomnia etiology, years of evolution, number of previously used drugs, and the results of perampanel for insomnia after 3 months of treatment in the exposed cohort, measured by the improvement of 3 or more points in the ISI and Pittsburgh scales, as well as the average of hours of sleep gained. Non-exposed patients were matched with this variables, but never treated with perampanel. RESULTS: We have included 66 patients. In the exposed cohort: we describe 33 patients with chronic resistant insomnia, 20 women (60 %), 13 men (40 %). Average age 53.48 years, average time of evolution: 11.25 years. Main etiology: depression 13 cases (40 %). After the combination of perampanel 2-4 mg (100 %) with antidepressants (17 cases, 51.5 %) or anxiolytics (12 cases, 36.36 %) along 3 months: the total number of hours of sleep improves in 2.5 h, the scale ISI improves by 6 points (± 2.1 SD, p = 0.02), and Pittsburgh scale improves in 4 points (± 1.7, p = 0.04). In non-exposed cohort, the improvement of the ISI scale was 2.2 points (±0.8, p = 0.06), on the Pittsburgh scale was 1.6 points (± 0.5, p = 0.01). The main adverse effect was irritability in 3 patients, without withdrawal perampanel. The treatment was abandoned by 4 patients (12.12%): 1 due to persistent irritability (3%), 2 due to lack of efficacy (6 %), 1 due to pregnancy wish (3 %). CONCLUSION: The combination of Perampanel with an antidepressant, or an anxiolytic, improves the quality of sleep measured by ISI and Pittsburgh scales (statistically significant), probably due to its antagonistic action on glutamate. A clinical trial compared with placebo would be necessary to corroborate these results.