Objective: To explore the efficacy and safety of perampanel in the treatment of paroxysmal kinesigenic dyskinesia (PKD)

Background: Perampanel is a new type of antiepileptic drug. PKD is a rare kind of movement disorder, which characterized by episodes of involuntary movements triggered by sudden movement. Antiepileptic drugs, especially carbamazepine and oxcarbazepine, have demonstrated good effect in the treatment of PKD. However, it has no effect on some patients and part of patients have serious adverse drug reactions. We aim to evaluate the efficacy and safety of perampanel in patients with PKD.

Method: We recruited patients with PKD who visited Shanghai Sixth People’s Hospital between July 2022 and February 2023. The patients were treated orally with 2mg perampanel every night. Efficacy and safety were evaluated 8-12 weeks after administration. We finally completed the follow-up of 15 patients. We collected the clinical information concerning the PKD attacks. The severity of PKD was assessed from six perspectives: limbs affected, face involvement, balance, frequency of aura, frequency of attacks, duration of attacks. Wilcoxon Matched-Pairs Signed ranks test was performed by SPSS Statistics 26.

Results: 15 patients with PKD (Male: 12, Female: 3) took perampanel for controlling the attacks. The average age at visit was 17.13 years (10-28 years) and the average age at onset was 10.93 years (5-16 years). The genetic testing was performed in 13 patients, and found that 5 patients have PRRT2 gene mutation. After the administration of perampanel, 3(20%) patients only have aura without the occurrence of attacks. The frequency of attacks was significantly reduced (z=-2.495, p=0.013), as well as the frequency of aura (z=-2.486, p=0.013). And the face involvement was also improved (z=-2.226, p=0.026) [Table]. The rank of duration of attacks, limbs affected and balance were also improved, while there is no statistical significance. 4(26.67%) patients reported somnolence during the administration of perampanel.

Conclusion: Perampanel acts as non-competitive antagonist of AMPA glutamate receptor. Current studies suggest that the pathophysiology of PKD is highly related with the glutamate receptor. Our study shows that perampanel is effective in PKD treatment, especially reducing the frequency of attacks. For patients with allergy to carbamazepine, perampanel could be an alternative treatment option.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/efficacy-of-perampanel-in-paroxysmal-kinesigenic-dyskinesia/