Kazuki Oi1, Shuichiro Neshige2, Takefumi Hitomi3, Katsuya Kobayashi1, Maya Tojima1, Masao Matsuhashi4, Akihiro Shimotake4, Daiki Fujii5, Riki Matsumoto6, Shuhei Kasama7, Masutaro Kanda8, Yoshiaki Wada9, Hirofumi Maruyama10, Ryosuke Takahashi1, Akio Ikeda11. 1. Department of Neurology, Kyoto University Graduate School of Medicine, Japan. 2. Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan; Department of Futaba Emergency General Medicine Supportive Center, Fukushima Medical University, Japan. 3. Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan. 4. Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan. 5. Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Neurology, Kurashiki Central Hospital, Japan. 6. Department of Neurology, Kyoto University Graduate School of Medicine, Japan; Department of Neurology, Kobe University Graduate School of Medicine, Japan. 7. Department of Neurology, Hyogo College of Medicine, Japan. 8. Department of Neurology, Takeda General Hospital, Japan. 9. Department of Rehabilitation, Nissan Tamagawa Hospital, Japan. 10. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan. 11. Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Japan. Electronic address: akio@kuhp.kyoto-u.ac.jp.
Abstract
OBJECTIVE: To elucidate the effects of perampanel (PER) on refractory cortical myoclonus for dose, etiology and somatosensory-evoked potential (SEP) findings. METHODS: We examined 18 epilepsy patients with seizure and cortical myoclonus. Based on data accumulated before and after PER treatment, correlations among clinical scores in myoclonus and activities of daily life (ADL); early cortical components of SEP; and PER blood concentration, were analyzed. RESULTS: PER (mean dose: 3.2 ± 2.1 mg/day) significantly improved seizures, myoclonus and ADL and significantly decreased the amplitude of and prolonged latency of giant SEP components. The degree of P25 and N33 prolongations (23.8 ± 1.6 to 24.7 ± 1.7 ms and 32.1 ± 4.0 to 33.7 ± 3.4 ms) were significantly correlated with improved ADL score (p = 0.019 and p = 0.025) and blood PER concentration (p = 0.011 and p = 0.025), respectively. CONCLUSIONS: Low-dose PER markedly improved myoclonus and ADL in patients with refractory cortical myoclonus. Our results suggest that SEP, particularly P25 latency, can be used as a potential biomarker for assessing the objective effects of PER on intractable cortical myoclonus. SIGNIFICANCE: In this study, PER lessened the degree of synchronized discharges in the postsynaptic neurons in the primary motor cortex.
OBJECTIVE: To elucidate the effects of perampanel (PER) on refractory cortical myoclonus for dose, etiology and somatosensory-evoked potential (SEP) findings. METHODS: We examined 18 epilepsypatients with seizure and cortical myoclonus. Based on data accumulated before and after PER treatment, correlations among clinical scores in myoclonus and activities of daily life (ADL); early cortical components of SEP; and PER blood concentration, were analyzed. RESULTS: PER (mean dose: 3.2 ± 2.1 mg/day) significantly improved seizures, myoclonus and ADL and significantly decreased the amplitude of and prolonged latency of giant SEP components. The degree of P25 and N33 prolongations (23.8 ± 1.6 to 24.7 ± 1.7 ms and 32.1 ± 4.0 to 33.7 ± 3.4 ms) were significantly correlated with improved ADL score (p = 0.019 and p = 0.025) and blood PER concentration (p = 0.011 and p = 0.025), respectively. CONCLUSIONS: Low-dose PER markedly improved myoclonus and ADL in patients with refractory cortical myoclonus. Our results suggest that SEP, particularly P25 latency, can be used as a potential biomarker for assessing the objective effects of PER on intractable cortical myoclonus. SIGNIFICANCE: In this study, PER lessened the degree of synchronized discharges in the postsynaptic neurons in the primary motor cortex.
Authors: Giovanni Assenza; Cristofaro Nocerino; Mario Tombini; Giancarlo Di Gennaro; Alfredo D'Aniello; Alberto Verrotti; Alfonso Marrelli; Lorenzo Ricci; Jacopo Lanzone; Vincenzo Di Lazzaro; Leonilda Bilo; Antonietta Coppola Journal: Front Neurol Date: 2021-03-24 Impact factor: 4.003