Sleep effects in drug-resistant epileptic patients taking perampanel: an observational study

Background: Perampanel (PER) is a selective non-competitive antagonist of the AMPA receptor. While its efficacy in epilepsy very limited studies have focused on its impact on sleep quality, thus the aim of this study was to assess PER impact on sleep among patients with refractory epilepsy. Methods: Patients were recruited at the Epilepsy Center of the University of Messina, Italy according to the ILAE criteria and received PER as an add-on therapy. Sleep quality (PSQI), daytime sleepiness (ESS), and quality of life (QOLIE-31) were assessed at baseline and follow-up. Efficacy was evaluated based on seizure frequency reduction and classified as worsened, unchanged, < 50% improvement, ≥ 50% improvement, or seizure-free. Patients were also stratified by use of perampanel as first or late add-on therapy. Tolerability was assessed through reported adverse events. Results: Thirty-one patients were followed for six months; one was excluded due to seizure worsening. PER was first add-on in 11 patients, late add-on in 20. Sleep quality and daytime sleepiness showed slight improvement. QOLIE-31 scores showed a mild, non-significant improvement in quality of life, with a significant reduction in seizure worry in late add-on patients. In the first group, 100% were responders (≥ 50% seizure reduction), 27.2% seizure-free. In the late add-on group, 65% were responders, 30% seizure-free (p = 0.043). PER was well tolerated with no severe adverse events. Significance: PER appears to preserve sleep quality and mildly improve quality of life. Furthermore, PER shows greater efficacy when used as a first add-on therapy in drug-resistant epilepsy.