Perampanel effects on seizures and sleep quality in people with epilepsy: A prospective multicenter study

Objective: Preliminary studies suggested a potential beneficial effect of perampanel (PER) on sleep in people with epilepsy (PwE). The present multicenter study evaluated the clinical potential of the early use of PER in PwE on seizures and on sleep quality, insomnia, daytime sleepiness and circadian rhythm preferences, as well as on depressive symptoms and quality of life. Methods: PwE starting PER as early add-on antiseizure medication were evaluated at baseline (T0) and after six months of treatment (T1) using standardized questionnaires: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Morningness–Eveningness Questionnaire (MEQ), and the Quality of Life in Epilepsy Inventory (QoLIE-31). Results: 74 PwE (44.6 % male, mean age 42.41 ± 18.06 years) were included and 59 PwE completed the study. At T1, 45.76 % (27/59) of PwE were seizure-free and significant reduction of seizures was found (10.80 ± 20.72 vs. 5.93 ± 16.77, p = 0.002). At T1, a significant improvement in sleep quality (PSQI, 7.18 ± 4.27 vs. 4.63 ± 3.09, p = 0.001) was evident, and particularly in sleep duration and efficiency and in the use of sleeping medications. Insomnia symptoms (ISI, 8.15 ± 6.23 vs. 5.32 ± 5.25, p = 0.002) and quality of life (QOLIE-31, 58.32 ± 16.57 vs. 65.81 ± 16.31, p = 0.033), mainly social functioning and perceived well-being, also significantly improved. No significant changes emerged for daytime sleepiness, circadian preference and depressive symptoms. Discussion: These findings suggest that PER may represent a valid therapeutic option for PwE, and particularly in who presents sleep impairment and insomnia.