Perampanel May Improve Insomnia in Patients With Epilepsy and Anxiety

Sang-ahn Lee, MD, PhD

Results from a study analyzing the effect of perampanel (Fycompa; Eisai) suggest the non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist may improve insomnia by decreasing anxiety in patients with epilepsy. Furthermore, the findings imply that the drug should be considered for treating patients who suffer from both insomnia and anxiety.

Perampanel was observed to be associated with lowered Insomnia Severity Index (ISI) scores in patients with anxiety (B = -5.909; P = .001), but did not demonstrate a significant effect in those without anxiety (P = .431). There was a clinically significant interaction between anxiety-by-perampanel and insomnia on the analysis of covariance (P = .029).

The data, collected by researchers from Asan Medical Center and Pusan National University Yangsan Hospital, including Sang-ahm Lee, MD, PhD, of Asan’s department of neurology, were accepted to be presented the American Academy of Neurology (AAN) 2020 Annual Meeting.

The cross-sectional study, conducted at Asan Medical Center, aimed to analyze the effect of perampanel on insomnia in 126 patients with epilepsy. Researchers used questionnaires to gain data on ISI, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Epworth Sleepiness Scale (ESS), and sleep apnea (STOP-BANG).

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Co-variables such as the basic profile of the participants and epilepsy-related factors were included in the study. Those who received perampanel for more than 16 weeks were labeled into the “On-perampanel” group, while those who did not receive the drug were placed into the “No-perampanel” group.

Researchers calculated the correlation between perampanel usage and insomnia through univariate analysis. Additionally, multiple linear regression was done to analyze the factor correlating with insomnia while adjusting possible confounding factors. Dependent variables were set with P <.1 on the univariate analysis while independent variables were set as ISI score. Analyzing interaction between perampanel and factors with P <.5 in multiple linear regression was done through an analysis of covariance.

Through multiple linear regression, PHQ-9 scores >10 (B = 5.515; P = .000), GAD-7 scores ≥7 (B = 4.515; P = .002) and perampanel use (B = -3.729; P = .003) showed correlation with ISI scores after the univariate analysis did not show correlation between ISI scores and perampanel (P = .46).

Perampanel has had a long run of tests for patients with epilepsy. It was previously approved by the FDA as adjunctive therapy for primary generalized tonic-clonic seizures (GTCS) in patients with epilepsy age 12 and older, as well as monotherapy for partial-onset seizures (POS) with or without secondary generalized seizures in patients with epilepsy age 12 and older. Eisai recently released data in January 2020 demonstrating perampanel’s generally safe, well-tolerated, and efficacious profile in children with focal seizures (FS) with and without focal to bilateral tonic-clonic seizures (FBTCS) and GTCS.

At the 73^rd annual meeting of the American Epilepsy Society (AES), December 6-10, 2019, Eisai presented data that showed perampanel displayed favorable retention rates and sustained efficacy for adolescents during routine clinical care.

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REFERENCE

Jung M, Jo S, Kim HJ, Kim H, Koo YS, Lee S. Perampanel may improve insomnia through a decrease in anxiety in patients with epilepsy. Neurology. 2020;94(15 Suppl): 2068.