Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures

Purpose: The purpose of this study was to evaluate subjective sleep quality and daytime sleepiness in patients receiving adjunctive perampanel for focal seizures. Methods: We conducted a multicenter, prospective, interventional, open-label study in patients aged >16 with focal seizures who received adjunctive perampanel (flexible dosing: 2-12 mg). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS) at baseline and 3 and 6 months after initiating perampanel. Patients with modifications in their baseline AEDs or sleep medications were excluded. Results: In 72 patients with drug-resistant focal seizures, mean baseline PSQI score (+/- standard deviation) was 7.26 (+/- 4.6), and ESS was 6.19 (+/- 4.2). At 3 months (median perampanel dose: 4 mg), there was no significant mean change from baseline in ESS score (n = 61) and a significant improvement in PSQI (-1.51 points; n = 44; p = 0.007), driven mainly by improved sleep efficiency (p = 0.012). In the 31 patients with 6-month data, ESS (but not PSQI) improved significantly at 6months vs baseline (p = 0.029). The only factor significantly correlated with sleep parameters was number of baseline AEDs (higher number correlated with worse daytime sleepiness). Seizure frequency was reduced significantly from baseline at 3 and 6 months. In bivariate analysis, neither PSQI nor ESS was associated with seizure frequency, suggesting that the changes in daytime sleepiness and sleep quality may be independent of the direct effect on seizures. Conclusion: Adjunctive perampanel did not worsen sleep quality or daytime sleepiness at 3 months and reduced daytime sleepiness in patients continuing perampanel for 6 months. Perampanel may be a suitable AED in patients with sleep disorders, in addition to refractory focal seizures. (C) 2016 Elsevier Inc. All rights reserved.