Objective To observe the efficacy and adverse reactions of pirenpanet in patients with refractory epilepsy treated with add-on therapy. MethodsForty-one patients with medically refractory epilepsy were selected from January 2021 to December 2021 in the Department of Epilepsy of Jiamusi Central Hospital, among which 25 males and 16 females. The self-control study was conducted before and after the treatment with pirenpanet. The observation period was 1 year, and the clinical efficacy, platelet, liver and kidney function and EEG discharge index were observed at 6 months and 12 months respectively. Changes in seizure frequency after treatment were divided into the following 3 groups: effective control: no seizure; effective: seizures reduced by 50% ~ 99%; Ineffective: < 50% reduction in seizures or exacerbation. Results Among the 41 patients with drug-refractory epilepsy, 8 (8/41, 19.51% P < 0.05) were seizure-free, 17 (17/41, 41.46% P < 0.05) were effective, and the total effective rate was (25/41, 60.98%); Sixteen cases (16/41, 39.02%) were ineffective. There were 31 children in 41 cases (31/41, 75.61%), of which 18 cases (18/31, 58.06%) were effective, 16 cases (16/31, 51.61%) had mental and motor retardation, and 8 cases (8/16, 50%) were effective; There were 10 adults (10/41, 24.39%) and 7 effective patients (7/10, 70%). After one year's treatment, the EEG changes of the patients were observed, and the abnormal discharge of 6 patients was reduced according to the discharge index, 2 patients had no abnormal discharge, and the other patients had no obvious EEG changes. Conclusion Pirenpanet is effective and safe as an add-on therapy for medically refractory epilepsy.
ObjectiveTo observe and compare the epileptic seizures, EEG changes and adverse reactions of perampanel and levetiracetam monotherapy in children with focal epilepsy. To explore the efficacy and safety of Perampanel monotherapy in the treatment of focal epilepsy and its relationship with miR-106b and autophagy related protein pathwaynide monotherapy in the treatment of focal epilepsy. Methods A total of 74 children with focal epilepsy in Xuzhou Children’s Hospital from March 2021 to December 2023 were selected as the research objects, all of whom were randomly divided into perampanel group and levetiracetam group. They were treated with perampanel and levetiracetam respectively. The clinical seizures, epileptiform discharges of EEG and adverse reactions were recorded and compared between the two groups. 2 mL of fasting peripheral blood were collected from the two groups of children in the morning, and the RNA of lymphocytes in the blood sample was extracted, the expression of miR-106b in peripheral blood lymphocytes of children was detected by qRT-PCR amplification, the levels of autophagy related protein Beclin-1, LC3-Ⅱ and p62 in the peripheral blood of children were detected by enzyme-linked immunosorbent assay. Results There was no significant difference in age, gender, BMI, course of disease, seizure frequency, epileptiform discharge index of EEG between the two groups (P>0.05). Seizure control: After treatment, the total effective rate and retention rate were 81.1% (30/37) and 78.4% (29/37) in the perampanel group and 59.5% (22/37) and 56.8% (21/37) in the levetiracetam group, respectively. The total effective rate in the perampanel group was higher than that in the levetiracetam group, with statistical difference (P<0.05). The retention rate in the perampanel group at 12 months was higher than that in the levetiracetam group, with statistical difference (P<0.05). EEG improvement: after treatment, the control improvement rate and total improvement rate of EEG in perampanel group were 32.4% (12/37) and 78.4% (29/37), and the control improvement rate and total improvement rate of EEG in levetiracetam group were 16.2% (6/37) and 56.8% (21/37), respectively, with statistical difference between the two groups (P<0.05). EEG in perampanel group was significantly improved. Adverse reactions: the incidence of adverse reactions in the perampanel group and Levetiracetam group was 10.8% (4/37) vs 24.3% (9/37). There was no statistical difference between the two groups (P>0.05). MiR-106b and autophagy related proteins: the expression of miR-106b, Beclin-1, LC3-Ⅱ in perampanel group was significantly decreased compared with that before treatment, with statistical differences (P<0.05). The expression of p62 was also increased compared with that before treatment, with obvious differences (P<0.05). There was no significant difference in the expression of miR-106b, Beclin-1, LC3-Ⅱ, p62 between levetiracetam group and perampanel group (P>0.05). Conclusion The clinical efficacy of perampanel as the first choice for the treatment of children with focal epilepsy is better than levetiracetam, which can effectively control seizures, improve the EEG of children, and has a low incidence of drug-related adverse events. Perampanel may exert antiepileptic effect by affecting miR-106b and autophagy related proteins.
ObjectiveTo investigate the efficacy and safety of Perampanel (PER) monotherapy in the treatment of self limited epilepsy with central temporal spikes (SeLECTS). Methods The clinical data of the first confirmed SelECTS in the outpatient and inpatient department of Xuzhou Children's Hospital affiliated to Xuzhou Medical University in December 2021 were collected, and the clinical data of PER monotherapy were retrospectively analyzed. The Seizure of 12 months old children were followed up to observe the efficacy and safety of PER monotherapy with spikes in the central temporal region, and the changes of Electroencephalography were observed. Result A total of 45 children with SeLECTS were included, of which 43 had complete medical records, including 13 males and 30 females, aged 4 ~ 14 years old, with a course of disease ranging from 1 month to 1.5 years. All 45 patients had focal seizures or focal secondary generalized tonic clonic seizures. Among them, 43 patients treated with PER alone for 12 months had epilepsy control efficacy rates of 74.41% (32/43) and no seizure rates of 60.46% (26/43), respectively. Seven children (15.56%, 7/45) experienced adverse reactions, characterized by dizziness, unstable gait, and irritability. Conclusion The third generation anti Seizure drug PER has a clear effect in the treatment of SelECTS, 2 ~ 4 mg PER can control Seizure well, and has no significant impact on cognitive development.
Objective To explore the efficacy and safety of Perampanel (PER) monotherapy in children with focal epilepsy. Methods Forty-six children with focal epilepsy who were newly diagnosed in the Department of Neurology of Wuxi Children's Hospital and had not used anti-seizure medications during January 2021 to June 2022 were selected, including 24 males and 22 females, with an average age of (7.2 ± 2.4) years old. Mono-therapy of PER as the PER group (23 cases), mono-therapy of Levetiracetam (LEV) as the LEV group (23 cases). Compare the clinical efficacy and adverse reactions between the two groups. Result The total effective rate was 87.0% (20/23) in PER group and 73.9% (17/23) in LEV group after 3 months of treatment (P<0.05); the total effective rate in the PER group was 78.3% (18/23), and 60.9% (14/23) in the LEV group after 6 months of treatment (P<0.05). The differences were statistically significant. In the PER group, 2 children had adverse reactions, 1 case was lethargic, and 1 case was dizziness. By temporarily reducing the drug dose and slowing the rate of dosing, the adverse reactions disappeared. In LEV group, 3 children had adverse reactions, all of who were irritable in varying degrees. By slowing down the rate of drug addition, 2 children’s symptoms disappeared and 1 child's symptoms relieved during 3 ~ 6 months. Conclusion The new anti-seizure medication — PER has a better anti-epileptic effect on focal epilepsy, which is better than LEV. The adverse reactions of both drugs are less and mild, and can be selected according to clinical conditions.