Clinical outcomes of perampanel vs. lacosamide in cohorts of consecutive patients with severely refractory epilepsies — A monocentric retrospective analysis of systematically collected data from the German Kork Epilepsy Center

PURPOSE Perampanel (PER) and lacosamide (LCM) are antiepileptic drugs (AEDs) approved for the adjunctive treatment of partial-onset seizures. At the time of market entry, information on clinical effectiveness of new AEDs is limited to results from pivotal trials, real-life or comparative data are missing. This analysis of data collected retrospectively in a German epilepsy center used unified evaluation criteria, and describes treatment outcomes with LCM and PER at 6 months. METHODS Results of the first 70 consecutive patients who had received LCM or PER after their market entries in Germany were compared. Outcome measures comprised 50% responder rates, seizure freedom, retention, and incidence of adverse events (AEs). RESULTS The mean number of previous AEDs was 8.7 in the PER group, and 7.3 in the LCM group. At 6 months, the 50% responder rate for all seizures was 48.6% for PER, and 28.6% for LCM, with seizure freedom in 14.3% of patients with PER, and 4.3% with LCM. Thirty-two AEs were reported for LCM, and 51 for PER, most commonly dizziness (22.9% of patients) for LCM, and somnolence/tiredness for PER (41.4%). AEs were reported as primary reason for discontinuation in 3 patients of the PER group. Retention rates were similar. CONCLUSIONS This analysis describes initial comparative benefits of two newly available AEDs in two cohorts of patients with highly refractory epilepsies. Responder and seizure freedom rates were numerically higher for PER. The analysis suggests that new AEDs can provide a chance for seizure freedom in relevant subgroups of patients, despite previous failure of multiple AEDs.