Perampanel Improves Comorbid Intellectual Disability, Effects of CBTip in PNES, Cenobamate's Impact in Surgically-Refractory Patients

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This week Neurology News Network covered a trio of presentations from the 2021 American Epilepsy Society Annual Meeting, including the use of perampanel in patients with comorbid intellectual disability, how Cognitive Behavioral Therapy-informed psychotherapy helps improve seizure frequency, and the additive benefits of cenobamate in patients who are refractory to epilepsy surgery.

Marco Meglio: Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Results from a post-hoc analysis of the PERMIT study, a pooled analysis of 44 real-world studies, showed that perampanel (Fycompa; Eisai) is effective in treating patients with epilepsy who have comorbid intellectual disability (ID), although the data was not as pronounced compared with those without ID. The findings also showed that the antiseizure medication (ASM) was generally well-tolerated in both groups, with the incidence of psychiatric adverse events (AEs) higher among those with ID. PERMIT originally included more than 5000 patients with focal-onset and/or generalized-onset seizures treated with perampanel in everyday clinical practice, however, this analysis included 735 patients with ID and 1890 patients without ID. Mean time on perampanel treatment was similar for patients with versus without ID. At last visit or 12 months, responder rate, defined as at least 50% seizure reduction from baseline, was observed in 37.5% of those with ID and in 48.5% of those without ID.

Results from a retrospective study found significant improvements in seizure frequency, anxiety, and depression in patients with psychogenic nonepileptic seizures (PNES) when treated with Cognitive Behavioral Therapy-informed psychotherapy (CBTip) for more than a 12-week period.This 2-part analysis included 160 patients who were treated with at least 7 sessions of CBTip for a 12-week period. The first analysis looked at change in outcomes in pretreatment and 90-day patient reported outcome (PRO) scores, whereas the second analysis looked at those in a flexible treatment schedule by comparing pretreatment scores with 90-day to 1-year post initial visit scores. In the second analysis, Tilahun and colleagues identified a significant improvement in seizure frequency, and anxiety symptoms. Only 10 patients had data from seizures per day in 6 months, and 5 (50%) improved by 50% or more in the number of seizures per day.

A post hoc analysis presented at the 2021 American Epilepsy Society (AES) Annual Meeting, December 3-7, in Chicago, Illinois, showed that treatment with cenobamate (Xcopri; SK Life Science) provides additional seizure freedom (SF) benefit for patients with uncontrolled focal seizures taking 1-3 antiseizure medications (ASMs) who were refractory to a prior epilepsy-related surgery.The data was from the long-term, phase 3, open-label C021 safety study, which included 1347 patients aged 18-70 years old. In total, 240 patients had focal seizure data available, of which 177 were still receiving study drug as of data cut-off. Mean duration of time on-study for those patients was 33.6 months. Eighty-five (35.4%) of the available cohort had prior epilepsy-related surgery, and in this group, 23.5% (20 of 85) achieved seizure freedom for at least 12 months since last clinic visit while 30.6% had seizure freedom for at least 12 months during any interval.

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