An Evaluation Of The Effectiveness Of Perampanel In People With Epilepsy Who Have Previously Undergone Resective Surgery And/Or Implantation Of A Vagal Nerve Stimulator

About 30% of people with epilepsy (PWE) are drug-resistant. Those with focal seizures may be suitable for epilepsy surgery. Those not amenable to resective surgery can be considered for vagus nerve stimulation (VNS). However, after operative procedures, around 50% of patients continue to experience seizures.A multi-center retrospective study assessing perampanel effectiveness and tolerability for PWE who have undergone surgical resection and/or VNS implantation was performed. The primary outcome was >= 50% reduction in seizure frequency while secondary outcomes included side effects (SEs), doserelated effectiveness, and toxicity. The median perampanel dose was 6 mg. Only one PWE became seizure free. A >= 50% decrease in seizure frequency was observed in 52.8% of the post-resection group and 16.9% of the VNS group (p < 0.001), while SEs were seen in 44.8% and 41.1%, respectively. Perampanel doses greater than 8 mg led to better response in both groups, especially in the post-VNS cohort. SEs were not dose-related and the safety profile was similar to previous observational studies.Perampanel can be beneficial in these two super-refractory epilepsy groups, particularly in PWE with seizures after surgical resection. Doses of more than 8 mg appear to be well tolerated and may be more effective than lower doses in PWE after surgical interventions. (C) 2020 Elsevier Inc. All rights reserved.