Evaluating the longer-term cognitive effects of adjunctive perampanel compared to lacosamide in a naturalistic outpatient setting.
PURPOSE
This retrospective longitudinal study aims to compare the longer-term cognitive and behavioral side effects of adjunctive antiepileptic treatment with perampanel (PER) and lacosamide (LCM), two third generation antiepileptic drugs with suggested favorable cognitive profiles. The two drugs were monitored according to a previously established routine diagnostic protocol (Helmstaedter et al. E&B 2013;26:182-7) which facilitates the retrospective comparison of antiepileptic drug tolerability in a naturalistic outpatient setting.


METHODS
Records from 94 patients were evaluated who underwent neuropsychological assessment before and under adjunctive treatment with either PER (n = 57) or LCM (n = 37). Cognition was assessed using the EpiTrack screening for executive functions and a VLMT short form for verbal memory. Subjective assessments included a German QOLIE-10 adaptation (quality of life) and an extended Adverse Events Profile (AEP). The median follow-up interval was 36 weeks.


RESULTS
Multivariate repeated measures statistics revealed a non-significant trend towards an interaction effect "time - treatment arm" on both executive function and memory. When analyzed separately executive functions and memory scores significantly improved under LCM (t = -2.76 p < 0.01 and t = -2.44 p < 0.05 respectively). Subjectively, PER was associated with improvements in 2/18 physiological domains and in the LCM group 1/9 cognitive domains deteriorated. Seizure freedom was achieved for five patients treated with LCM (14%) and 15 treated with PER (26%, χ2 = 2.2, n.s.).


CONCLUSION
In a naturalistic outpatient setting, chronic adjunctive treatment with PER and LCM did not negatively affect cognition and LCM may even improve cognition. Neither drug increased self-reported irritability or aggression. This suggests favorable longer-term tolerability.
['Meschede|Carolin|C|', 'Witt|Juri-Alexander|JA|', 'Rademacher|Michael|M|', 'von Wrede|Randi D|RD|', 'Elger|Christian E|CE|', 'Helmstaedter|Christoph|C|']
D000081:Acetamides D000328:Adult D000927:Anticonvulsants D003071:Cognition D004359:Drug Therapy, Combination D004827:Epilepsy D056344:Executive Function D005260:Female D005500:Follow-Up Studies D006801:Humans D000078334:Lacosamide D008137:Longitudinal Studies D008297:Male D008568:Memory D015999:Multivariate Analysis D009483:Neuropsychological Tests D009570:Nitriles D010045:Outpatients D011728:Pyridones D011788:Quality of Life D012189:Retrospective Studies D016896:Treatment Outcome
Cognition Perampanel Lacosamide Antiepileptic drugs Neuropsychology Epilepsy