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.
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 the efficacy and safety of lacosamide (LCM) as a monotherapy or as an add-on in the treatment of focal epilepsy in children aged 4 months to 4 years. MethodsThe study included 20 children with focal epilepsy who received oral LCM monotherapy or add-on therapy in Children's Hospital Affiliated to Soochow University from March 2022 to September 2022, including 9 males and 11 females with an average age of (22.4±13.0) months. The curative effects and adverse reactions at 1, 2, 3, 4, and 6 months after LCM treatment were analyzed. The initial dose of LCM was 2 mg/(kg·d) and increased by 2 mg/(kg·d) every week, maintenance dose 6 ~ 12mg/(kg·d). Results During the follow-up period of this study, the total effective cases were 17 (85.00%), and the number of control-free cases was 15 (75.00%). Conclusion LCM can effectively reduce the frequency of epileptic seizures in the monotherapy or add-on treatment of infants and young children with focal epilepsy, with few adverse reactions and high retention rate, which has high clinical application value.
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.