Effect Of A New Antiepileptic Drug Perampanel On Cognition Of Epileptic Patients

Objective:At present,clinical studies show that epilepsy patients have different degrees of cognitive impairment,which is mainly caused by poor epilepsy control and side effects of Anti-Seizure Medications(ASM).Although traditional ASM can effectively control epileptic seizures,but because of its different mechanisms of action,in the control of epileptic seizures at the same time for the cognitive function of greater impact.Therefore,ASM with new mechanism of action has been developed and put on the market one by one and applied in clinic.In 2019,Perampanel(PER)was launched in China.As the third generation of new ASM,PER has a completely different mechanism of action from other ASM,and is the first highly selective non-competitive glutamate receptor antagonist for the treatment of epilepsy.At present,there are few related studies on the cognitive impact of PER on epilepsy patients in China.By analyzing the changes of cognitive scores of epileptic patients before and after PER treatment,this study studies the influence of PER on epileptic patients’ cognition,and provides reference for clinicians to accurately choose ASM for epileptic patients with cognitive impairment.Methods:A prospective cohort study was used to select epileptic patients who were diagnosed clearly in the outpatient and inpatient department of neurology in our hospital from January 2022 to December 2022.PER was added to the original ASM treatment and followed up for 6 months.Montreal Cognitive Scale(Mo-CA)and Mini Mental State Checklist(MMSE)were used to evaluate the cognitive function of the patients before,3 months and 6 months after treatment,and the scores of MMSE and Mo-CA before and after treatment were compared and analyzed to study the influence of ASM combined with PER on cognitive function of epileptic patients with different seizure types.Results:1.Baseline information:This study included 51 patients,including 27 males(52.9%)and 24 females(47.1%),with a median age of 30 years(21-66 years).There were 19 cases(37.0%)of generalized seizures,20 cases(39.0%)of focal seizures with disturbance of consciousness,and 12 cases(24.0%)of focal seizures without disturbance of consciousness.The median course of epilepsy was 60 months,and the median number of seizures per month was 2 times/month.EEG showed epileptiform discharge in 44 patients(86.3%)and no epileptiform discharge in 7 patients(13.7%).Brain MRI showed structural abnormality in 20 patients(39.2%)and no structural abnormality in 31 patients(60.8%).38 patients(75.0%)received sodium channel blocker(SCB)ASM and 13 patients(25.0%)received non-SCB ASM.2.Comparison of seizure frequency before and after PER treatmentAfter adding PER for 6 months,the monthly epilepsy frequency of 51 patients significantly decreased compared with that before adding PER(P<0.001)3.Comparison of total cognitive scores of 51 patients before and after PER treatmentThere was no significant difference in MMSE and Mo-CA scores between 51 patients treated with PER for 3 months and those before PER treatment(P>0.05);The scores of MMSE and Mo-CA in 6 months after PER treatment were significantly higher than those before PER treatment(P<0.05).4.Comparison of cognitive scores of patients with different attack types before and after PER treatmentThere was no significant difference in MMSE scores between the patients with general seizure group,focal seizure group with disturbance of consciousness and focal seizure group without disturbance of consciousness after PER treatment for 3 months and 6 months compared with those before PER treatment(P>0.05).The Mo-CA scores of patients with general seizure,focal seizure with disturbance of consciousness and focal seizure without disturbance of consciousness in 3 months after PER treatment were not significantly different from those before PER treatment(P>0.05);The Mo-CA scores of patients with focal seizure without disturbance of consciousness at 6 months after PER treatment were not significantly different from those before PER treatment(P>0.05),but the scores of patients with global seizure and focal seizure with disturbance of consciousness were significantly higher than those before PER treatment(P<0.05).5.Comparison of cognitive scores of patients with ASM with PER combined with different mechanisms before and after treatmentThere was no significant difference in MMSE score between SCB group and before PER treatment for 3 months(P>0.05),but there was significant difference in MMSE score between non-SCB group and before PER treatment(P<0.05);The MMSE scores of non-SCB patients after 6 months of PER treatment were not significantly different from those before PER treatment(P>0.05),but the scores of SCB patients were significantly higher than those before PER treatment(P<0.05).There was no significant difference in Mo-CA scores between SCB group and non-SCB group in 3 months after PER treatment compared with those before PER treatment(P>0.05),but there was significant difference in Mo-CA scores between the two groups in 6 months after PER treatment compared with those before PER treatment(P<0.05).Conclusion:1.PER addition therapy can effectively control epileptic seizures,and long-term use of PER may improve cognitive function of epileptic patients.2.PER can improve the cognition of patients with general seizure and focal seizure with disturbance of consciousness.3.PER combined with SCB or non-SCB has no negative effect on cognitive function of epileptic patients,and long-term combined treatment may improve cognitive function.