Article ID: 11180
Background: Poststroke epilepsy affects 10% of stroke patients and is known to be a factor contributing to poor functional outcomes. However, clear criteria for selecting anti-seizure medications have not yet been established. We investigated the long-term therapeutic effects of perampanel in poststroke epilepsy. Subjects and Methods: We studied 28 cases of poststroke epilepsy treated with perampanel at the Epilepsy Center and Neurosurgery Department of Tokyo Medical and Dental University and Tsuchiura Kyodo Hospital from June 2016 to April 2022. We examined patient backgrounds, drug dosages, concomitant drug use, side effects, seizure freedom, and tolerability rates at 3, 6, 12, and 24 months. Results: Of the 28 patients, 18 were male and ten were female, with a mean age of 55.8 years (range: 17–97 years). The stroke etiology was hemorrhagic in 20 patients (71.4%) and ischemic in 8 (28.6%). At the start of perampanel treatment, the mean number of concomitant drugs was 1.1 and the mean maintenance dose was 3.6 mg. Seizure freedom was 77%, 80%, 83%, and 80% at 3, 6, 12, and 24 months, respectively. Tolerability remained consistently above 80%. Favorable outcomes were particularly observed in patients with focal to bilateral tonic-clonic seizures. There were no significant differences in treatment outcomes based on etiology or the number of previous medications. Conclusion: Perampanel demonstrated high therapeutic efficacy and tolerability in poststroke epilepsy.
