Experience of Low Dose Perampanel to Add-on in Glioma Patients with Levetiracetam-uncontrollable Epilepsy
Experience of Low Dose Perampanel to Add-on in Glioma Patients with Levetiracetam-uncontrollable Epilepsy
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DOI：
10.2176/nmc.oa.2018-0245
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发表时间：
2020-01-01
影响因子：
1.9
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
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作者：
Chonan, Masashi;Saito, Ryuta;Tominaga, Teiji
在引入左乙拉西坦(LEV)后，对恶性脑肿瘤患者癫痫的治疗有了显著的改善。另一方面，我们仍然会遇到一些癫痫发作失控的病例。帕罗西汀(perampanel，PER)是一种非竞争性a-amino-3-hydroxy-5-methyl-4-isoaxazolepropionate酸受体拮抗剂，最近被批准作为次要药物用于治疗局灶性癫痫。关于神经胶质瘤患者每种药物治疗的现有文献报道仍然很少。在这里，我们报告了我们对胶质瘤患者的初步经验，并报告了在LEV单一疗法无法控制癫痫发作的患者中，在LEV中添加低剂量2-4 mg/次的疗效。对连续18例患者的临床结果数据进行了回顾。这包括9名男性和9名女性，年龄24-76岁(中位数，48.5岁)，在2009年6月至2018年12月期间接受治疗。我们对LEV失控癫痫患者增加了PER。两名患者出现不良反应、易激惹，但所有病例均可持续给药。4例出现癫痫发作，每次2 mg，17例以剂量递增的方式缓解发作，末次剂量2~4 mg/次，再加500~3000 mg。我们的研究揭示了低剂量每2-4毫克作为LEV的第一个附加治疗对于那些对LEV治疗失败或不能耐受的胶质瘤患者的抗癫痫效果。对于伴有LEV失控性癫痫的神经胶质瘤患者，低剂量的LEV治疗可能具有良好的疗效和可耐受的不良反应。
After introduction of levetiracetam (LEV), treatment of seizures in patients with malignant brain tumors has prominently improved. On the other hand, we still experience some cases with LEV-uncontrollable epilepsy. Perampanel (PER) is a noncompetitive a-amino-3-hydroxy-5-methyl-4-isoaxazolepropionate acid receptor antagonist that has recently been approved for treating focal epilepsy as a secondary drug of choice. Available literature reporting PER medication in patients with gliomas is still sparse. Here, we report our initial experience with glioma patients and report efficacy of adding low dose 2-4 mg PER to LEV in patients whose seizure were uncontrollable with LEV monotherapy. Clinical outcome data of 18 consecutive patients were reviewed. This included nine males and nine females aged 24-76 years (median, 48.5 years), treated for glioma between June 2009 to December 2018. We added PER to patients with LEV-uncontrollable epilepsy. Adverse effects, irritability occurred in two patients, but continuous administration was possible in all cases. Though epileptic seizures occurred in four cases receiving 2 mg PER, 17 cases achieved seizure freedom by dose increments; final dose, 2-4 mg PER added to LEV 500-3000 mg. Our study revealed anti-epileptic efficacy of low dose PER 2-4 mg as first add-on therapy to LEV in glioma patients who have failed or intolerable to LEV monotherapy. Low dose PER added on to LEV may have favorable efficacy with tolerable adverse effects in glioma patients with LEV-uncontrollable epilepsy.