Highlights
- •Epilepsy is a frequent symptom in brain tumor patients with significant impact on the quality of life.
- •Perampanel is an attractive novel add-on antiepileptic drug for seizure control in brain tumor patients.
- •In two cases with SMART-syndrome, seizure control was achieved after initiation of perampanel add-on treatment.
Abstract
Epilepsy is common in patients with brain tumors and frequently presents as the first
clinical manifestation of an underlying tumor. Despite a number of available antiepileptic
drugs (AED), brain tumor related epilepsy (BTRE) may still be difficult to control.
Recently, the AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid)-type
glutamate receptor antagonist perampanel (PER) is increasingly acknowledged as an
attractive novel add-on AED for seizure control in BTRE. We present a single institutional
experience reporting five individual cases with refractory BTRE treated with PER.
In two of these five brain tumor patients, worsening of seizure control was caused
by SMART-syndrome (stroke-like migraine attacks after radiation therapy). Efficacy
of PER was assessed by the responder rate and by evaluating overall changes in seizure
frequency before and during PER treatment. In our case series, a reduction in seizure
frequency was observed in four out of five patients and the responder rate was 40%.
In addition, both cases with symptomatic epilepsy associated with SMART-syndrome were
successfully treated with PER. This case series supports the growing evidence that
PER may become a promising add-on AED for the treatment of refractory BTRE as well
as for seizure control in SMART-syndrome.
Keywords
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References
- Primary brain tumours in adults.Lancet. 2018; 392: 432-446
- Brain tumor-related epilepsy.Curr. Neuropharmacol. 2012; 10: 124-133
- ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology.Epilepsia. 2017; 58: 512-521
- Seizures in low-grade gliomas: natural history, pathogenesis, and outcome after treatments.Neuro-Oncology. 2012; 14: iv55-iv64
- Epileptogenesis and oncogenesis: an antineoplastic role for antiepileptic drugs in brain tumours?.Pharmacol. Res. 2020; 156: 104786
- The pathogenesis of tumor-related epilepsy and its implications for clinical treatment.Seizure. 2012; 21: 153-159
- Perampanel confirms to be effective and well-tolerated as an add-on treatment in patients with brain tumor-related epilepsy (PERADET study).Front. Neurol. 2020; 11: 592
- Does neuronal activity promote Glioma progression?.Trends Cancer. 2020; 6: 1-3
- Perampanel in brain tumor-related epilepsy: observational pilot study.Brain Behav. 2020; 10e01612
- Lacosamide in patients with gliomas and uncontrolled seizures: results from an observational study.J. Neuro-Oncol. 2018; 136: 105-114
- Seizures in Patients with Primary and Metastatic Brain Tumors.(Accessed 02.11 2020)
- Effectiveness and tolerability of lacosamide as add-on therapy in patients with brain tumor-related epilepsy: results from a prospective, noninterventional study in European clinical practice (VIBES).Epilepsia. 2020; 61: 647-656
- Effect of Brivaracetam on efficacy and tolerability in patients with brain tumor-related epilepsy: a retrospective multicenter study.Front. Neurol. 2020; 11: 813
- A systematic review and indirect treatment comparison of perampanel versus brivaracetam as adjunctive therapy in patients with focal-onset seizures with or without secondary generalization.Epilepsy Res. 2020; 166: 106403
- Fycompa (perampanel hydrate) receives expanded indication for primary generalized tonic-clonic seizures.Am. Health Drug Benefits. 2016; 9 (Spec Feature): 88
- New drug classes for the treatment of partial onset epilepsy: focus on perampanel.Ther. Clin. Risk Manag. 2013; 9: 285-293
- Eisai, Fycompa (Perampanel) Tablets [Prescribing Information].https://www.ema.europa.eu/en/documents/product-information/fycompa-epar-product-information_de.pdf(Accessed 02.11 2020)Date: August 2020
- Progress report on new antiepileptic drugs: a summary of the tenth EILAT conference (EILAT X).Epilepsy Res. 2010; 92: 89-124
- New and emerging treatments for epilepsy: review of clinical studies of lacosamide, eslicarbazepine acetate, ezogabine, rufinamide, perampanel, and electrical stimulation therapy.J. Epilepsy Res. 2011; 1: 35-46
- Efficacy and safety of adjunctive perampanel in adolescent patients with epilepsy: post hoc analysis of six randomized studies.Epilepsy Behav. 2020; 104: 106876
- Seizure response to perampanel in drug-resistant epilepsy with gliomas: early observations.J. Neuro-Oncol. 2017; 133: 603-607
- Perampanel in patients with brain tumor-related epilepsy in real-life clinical practice: a retrospective analysis.Int. J. Neurosci. 2019; 129: 593-597
- Experience of low dose Perampanel to add-on in Glioma patients with Levetiracetam-uncontrollable epilepsy.Neurol. Med. Chir. (Tokyo). 2020; 60: 37-44
- Non-convulsive status epilepticus with negative phenomena--a SMART syndrome variant.Seizure. 2015; 25: 49-51
- AMPA receptors as a molecular target in epilepsy therapy.Acta Neurol. Scand. Suppl. 2013; 197: 9-18
- Eisai, Fycompa (Perampanel) Tablets [Prescribing Information].
- IDH1/2 mutations in WHO grade II astrocytomas associated with localization and seizure as the initial symptom.Seizure. 2012; 21: 194-197
- Potential influence of IDH1 mutation and MGMT gene promoter methylation on glioma-related preoperative seizures and postoperative seizure control.Seizure. 2019; 69: 283-289
- Adjunctive perampanel for glioma-associated epilepsy.Epilepsy Behav. Case Rep. 2018; : 114-117
- Effect of valproic acid on seizure control and on survival in patients with glioblastoma multiforme.Neuro-Oncology. 2013; 15: 961-967
- Does valproic acid or levetiracetam improve survival in glioblastoma? A pooled analysis of prospective clinical trials in newly diagnosed glioblastoma.J. Clin. Oncol. 2016; 34: 731-739
- Perampanel inhibits Neuroblastoma cell proliferation through Down-regulation of AKT and ERK pathways.Anticancer Res. 2019; 39: 3595-3599
- Glutamatergic synaptic input to glioma cells drives brain tumour progression.Nature. 2019; 573: 532-538
- Electrical and synaptic integration of glioma into neural circuits.Nature. 2019; 573: 539-545
- Seizures and tumor progression in Glioma patients with uncontrollable epilepsy treated with Perampanel.Anticancer Res. 2018; 38: 4361-4366
- Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series.AJNR Am. J. Neuroradiol. 2013; 34: 2298-2303
- Stroke-like migraine attacks after radiation therapy syndrome: case report and review of the literature.Neuroradiol. J. 2017; 30: 568-573
- SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients.J. Child Neurol. 2014; 29: 336-341
- Normal cerebrovascular reactivity in stroke-like migraine attacks after radiation therapy syndrome.Clin. Nucl. Med. 2010; 35: 583-585
Article info
Publication history
Published online: March 05, 2021
Accepted:
March 3,
2021
Received in revised form:
March 2,
2021
Received:
January 13,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
