Wedesignedalongitudinalcohortstudyon People with Epilepsy (PwE) with the aimofassessingthe effect of Perampanel (PER) oncortico-subcortical networks, as measured by high-frequency oscillations of somatosensory evoked potentials (SEP-HFOs). SEP-HFOs measure the excitability of both thalamo-corticalprojections(early HFOs) and intracortical GABAergic synapses (late HFOs), thus they could be used to study the anti-glutamatergic action of PER, a selective antagonist of the AMPA receptor.
15 PwE eligible for PER add-on therapy, were enrolled prospectively. Subjects underwent SEPs recording from the dominant hand at two times: PwE (baseline, before PER titration) and PwE (therapeutic dose of 4 mg). HFOs were obtained by filtering N20 scalp response in the 400-800 Hz range. Patients were compared with a normative population of 15 healthy controls (HC) matched for age and sex.
We found a significant reduction ofTotal HFOs and mostly early HFOs area between PwE and PwE (p = 0.05 and p = 0.045 respectively) and between HC and PwE (p = 0.01). Furthermore, we found a significant reduction of P24/N24 Amplitude between PwE and HC and between PwE and PwE (p = 0.006 and p = 0.032, respectively).
Introduction of PER as add-on therapy reduced the area of total HFOs, acting mainly on the early burst, related to thalamo-cortical pathways. Furthermore P24/N24 amplitude, which seems to reflect a form of cortico-subcortical integration, resulted increased in PwE at T0 and normalized at T1.
Our findings suggest that PER acts on cortico-subcortical excitability. This could explain the broad spectrum of PER and its success in forms of epilepsy characterized by thalamo-cortical hyperexcitability.
Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.
About The Expert
Jacopo Lanzone
Marilisa Boscarino
Lorenzo Ricci
Angelo Insola
Mario Tombini
Vincenzo Di Lazzaro
Giovanni Assenza
References
PubMed