ObjectiveThrough neuropsychological assessment, explore the factors that may cause cognitive impairment in patients with focal epilepsy.MethodsCollected 53 epilepsy patients in outpatients and inpatients of Tianjin Medical University General Hospital from March 2016 to January 2020, including 25 males and 28 females, with an average age of (23.58±13.24) years old, and the course of disease (6.49±7.39), all met the 2017 ILEA diagnostic criteria for focal epilepsy, and there was no history of progressive brain disease or brain surgery. Carry out relevant cognitive assessments for the enrolled patients, use SPSS statistical software to conduct Spearman correlation analysis on the cognitive functions of the study subjects, and further analyze the related factors of cognition through Logistic regression analysis to clarify the factors related to cognition whether it may be a risk factor for cognitive impairment in patients with focal epilepsy.Results Spearman correlation analysis showed that the FIQ of patients with focal epilepsy was related to education level, age of onset, seizure pattern, total number of seizures, AEDs and EEG interval discharge side (P<0.05). Binary Logistic regression analysis shows that among all cognitive-related factors, only the number of AEDs (P=0.003) and EEG interval discharge (P=0.013) are the risk of cognitive impairment in patients with focal epilepsy factor.ConclusionIn the clinical treatment of epilepsy, seizures should be actively controlled, but the types of drugs should be minimized. When there are more than 3 kinds of drugs, surgical treatment or other non-surgical treatments can be considered. At the same time, the EEG should be reviewed regularly to understand the changes in epileptiform discharges between episodes.
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.
ObjectiveTo compare the efficacy and safety of perampanel (PER) and oxcarbazepine (OXC) monotherapy in the treatment of newly diagnosed focal epilepsy in adults. Methods A total of 62 adult patients with focal epilepsy, aged 18~79 years old, with an average age of (40.53±16.69) years, were enrolled from Qingyuan People’s Hospital between August 2021 and October 2022 and randomly divided into PER group and OXC groups. Both groups were followed up for 12 months and assessed for seizure free rate, effective rate, drug retention rate, and adverse reactions at 3, 6, and 12th months. ResultsThe results showed that the seizure free rate, effective rate, and drug retention rate in the PER group were 62.5%, 71.9% and 87.5% at 3 months, respectively, and 53.1%, 65.6% and 75.0% at 6 months respectively. In the OXC group, the seizure free rate, effective rate, and drug retention rate were 70.0%, 86.7%, and 93.3% at 3 months, respectively, and 66.7%, 73.3% and 83.3% at 6 months, respectively. At 12 months, the seizure free rate, effective rate and retention rate of the PER group were 43.8%, 46.9%, and 53.1%, respectively; The seizure free rate, effective rate, and retention rate of OXC group were 66.7%, 66.7%, and 70.0%, respectively. The incidence of adverse reactions in the PER group and OXC group was 15.6% and 16.7%, respectively. The most common adverse reactions in both groups were dizziness and drowsiness, with no serious adverse events. ConclusionPER and OXC monotherapy demonstrated similar efficacy and safety in the treatment of newly diagnosed adult focal epilepsy, and both drugs can be used as safe and effective treatment options.
Anti-seizure medications (ASMs) are the most important and basic treatment for epilepsy, and are also the first choice for epilepsy treatment, but about one-third of patients have drug resistance. Perampanel (PER), as a novel third generation ASMs, inhibits the α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor (AMPAR) through non-competitive inhibition. AMPA plays an anti-seizure role. Since its approval in China in 2021, it has been mainly used in the treatment of focal epilepsy (with or without general seizure) as a single drug or addition, and has good safety, effectiveness and tolerability. Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a common childhood focal epilepsy syndrome, accounting for 15% ~ 25% of various childhood epilepsies, PER has important advantages in clinical studies and has shown certain curative effect. At the same time, the overall effect of PER on cognition was neutral, with no systemic cognitive deterioration or improvement. In view of the relatively short application time of PER, which is still a new drug, this article will review the mechanism of action, dose, add-on (single drug) treatment, adverse events and, in order to provide clinicians with more drug choices and facilitate the individualized diagnosis and treatment of 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.
