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Effects of Perampanel on Cognition and Electroencephalography in Patients With Epilepsy

Primary Purpose

Electroencephalography

Status
Completed
Phase
Phase 4
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Perampanel
Sponsored by
Seoul National University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Electroencephalography focused on measuring Electroencephalography, Perampanel

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female subjects aged 18-65 years
  • Provide written informed consent signed by the subject or legal guardian prior to entering the study in accordance with the IRB guidelines
  • Subjects in otherwise good health (with the exception of epilepsy), as determined by the PI via the medical history, a physical examination and screening laboratory investigations including demonstration of normal renal function.
  • Patient with focal-onset seizures with or without secondary generalized seizure
  • History of epilepsy for at least 2 years.
  • The subject must have had an EEG or clinical seizure consistent with partial epilepsy.

Exclusion Criteria:

  • A history of non-epileptic or psychogenic seizures.
  • Women who are pregnant or lactating.
  • Any clinically significant laboratory abnormality which, in the opinion of the investigator, will exclude the subject from the study.
  • Liver transammases (AST and ALT) cannot exceed twice the upper limit of normal and total and direct bilirubin must be within normal limits.
  • An active CNS infection, demyelinating disease, degenerative neurological disease or any CNS disease deemed to be progressive during the course of the study that may confound the interpretation of the study results.
  • Any clinically significant psychiatric illness, psychological or behavioral problems which, in the opinion of the investigator, would interfere with the subject's ability to participate in the study.
  • Suffering from psychotic disorders and/or unstable recurrent affective disorders evident by use of antipsychotics; subject with current major depressive episode (or within 6 months).
  • A history of alcoholism, drug abuse, or drug addiction within the past 2 years.
  • History of regular alcohol consumption exceeding 2-3 units/day for females and 3-4 units/day for males
  • History of regular use of tobacco or nicotine-containing products exceeding the equivalent of 5 cigarettes per day
  • History of regular consumption of caffeine exceeding the equivalent of 4 cups of coffee per day, a level that approximates health-related criteria
  • Subject has had greater than 2 allergic reactions to an AED or one serious hypersensitivity reaction to an AED.
  • Subjects with more than 1 lifetime suicide attempt or any suicide attempt within the past two years.

Sites / Locations

  • Seoul National University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Epilepsy

Arm Description

Epilepsy patients (focal onset seizure with or without secondary generalization)

Outcomes

Primary Outcome Measures

Quantitative EEG (qEEG) change
Change of qEEG markers - spectral power: delta, theta, alpha and beta frequency band

Secondary Outcome Measures

Effects on cognition
global cognitive function: Mini-mental state examination Attention and working memory: Digit span forward and backward Frontal/Executive function: Stroop test, trail-making test (TMT, A -and B types), Controlled Oral Word Association test (COWA) Visuospatial function: Rey complex figure test Language: Short form of K-BNT Memory: The Korean version of the California Verbal Learning Test (KCVLT) for verbal memory and the Rey complex figure test of visual memory
Effects on sleepiness
Clinical questionnaire - Epworth Sleepiness Scale
Effects on seizures
Seizure frequency per month
Effects on depression
BDI (Beck Depression Index)

Full Information

First Posted
September 6, 2016
Last Updated
September 23, 2021
Sponsor
Seoul National University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02900755
Brief Title
Effects of Perampanel on Cognition and Electroencephalography in Patients With Epilepsy
Official Title
Effects of Perampanel on Cognition and Electroencephalography in Patients With Epilepsy
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
December 2016 (undefined)
Primary Completion Date
April 2019 (Actual)
Study Completion Date
November 20, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Seoul National University Hospital

4. Oversight

5. Study Description

Brief Summary
Perampanel, a novel AED, has been recently authorized in Korea and worldwide as a treatment of refractory partial-onset seizures with a new anti-epileptic mechanism of a selective non-competitive antagonist of AMPA receptors. Evaluating adverse effects during the introduction of new AED is often difficult since the complaints are subjective and objective assessment is complicated due to the polytherapy. Majority of previous studies are focused on quantitative analysis of EEG for taking new AEDs because of the correlation of EEG analysis results and side effects of AED such as cognitive slowing. Therefore, this study aims to investigate the effects of perampanel on EEG in terms of EEG background spectra and to evaluate perampanel effects by using subjective questionnaires assessing depression, anxiety, sleep quality and fatigue.
Detailed Description
Perampanel is a selective antagonist of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor and is used to treat partial-onset seizures with or without secondary generalization. This antiepileptic drug (AED) is usually prescribed as adjunctive treatment and is also used primarily in generalized tonic-clonic seizures Cognitive dysfunction is a major comorbidity in many patients with epilepsy and could be the result of chronic use of AEDs. Since cognitive decline has a tremendous impact on the quality of life, the effect of a large number of AEDs on cognition has been actively studied. It has been reported that AEDs such as gabapentin, carbamazepine, and topiramate induce cognitive decline, while lamotrigine, levetiracetam, and oxcarbazepine show much less negative effect on cognitive function compared with the older AEDs. Perampanel has also been studied for its effects on cognition in adolescent patients with epilepsy aged 12-18 years. However, the effects of perampanel on cognitive function have not yet been studied in adults. Electroencephalogram (EEG) spectral analysis or quantitative EEG (QEEG) is a method of quantifying the different frequencies in EEG signals. Spectral analysis of EEG frequency can reflect the functional state of the brain. Thus, it has proved to be a useful tool for assessing the pharmacological effects of central nervous system (CNS) drugs. Electrophysiologic changes due to AEDs can manifest as either a generalized slowing of or an increased beta frequency on EEG in general. Changes in background EEG may be correlated with clinical cognitive function. Since EEG changes in the spectral analysis are only intended to assess brain activity and do not directly reflect clinical changes in patients, neuropsychological (NP) tests are necessary for evaluating clinical cognitive function. Our objective was to determine how perampanel affects cognition and the EEG signal in adult patients with epilepsy. Correlation of these effects was also analyzed with the serum concentration of perampanel.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Electroencephalography
Keywords
Electroencephalography, Perampanel

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Epilepsy
Arm Type
Experimental
Arm Description
Epilepsy patients (focal onset seizure with or without secondary generalization)
Intervention Type
Drug
Intervention Name(s)
Perampanel
Other Intervention Name(s)
Fycompa
Intervention Description
The subjects will be administered oral perampanel for six months. Dose will be titrated according to the tolerance and be maintained at least 1 month before second EEG evaluation.
Primary Outcome Measure Information:
Title
Quantitative EEG (qEEG) change
Description
Change of qEEG markers - spectral power: delta, theta, alpha and beta frequency band
Time Frame
6th month
Secondary Outcome Measure Information:
Title
Effects on cognition
Description
global cognitive function: Mini-mental state examination Attention and working memory: Digit span forward and backward Frontal/Executive function: Stroop test, trail-making test (TMT, A -and B types), Controlled Oral Word Association test (COWA) Visuospatial function: Rey complex figure test Language: Short form of K-BNT Memory: The Korean version of the California Verbal Learning Test (KCVLT) for verbal memory and the Rey complex figure test of visual memory
Time Frame
6th month
Title
Effects on sleepiness
Description
Clinical questionnaire - Epworth Sleepiness Scale
Time Frame
6th month
Title
Effects on seizures
Description
Seizure frequency per month
Time Frame
6th month
Title
Effects on depression
Description
BDI (Beck Depression Index)
Time Frame
6th month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects aged 18-65 years Provide written informed consent signed by the subject or legal guardian prior to entering the study in accordance with the IRB guidelines Subjects in otherwise good health (with the exception of epilepsy), as determined by the PI via the medical history, a physical examination and screening laboratory investigations including demonstration of normal renal function. Patient with focal-onset seizures with or without secondary generalized seizure History of epilepsy for at least 2 years. The subject must have had an EEG or clinical seizure consistent with partial epilepsy. Exclusion Criteria: A history of non-epileptic or psychogenic seizures. Women who are pregnant or lactating. Any clinically significant laboratory abnormality which, in the opinion of the investigator, will exclude the subject from the study. Liver transammases (AST and ALT) cannot exceed twice the upper limit of normal and total and direct bilirubin must be within normal limits. An active CNS infection, demyelinating disease, degenerative neurological disease or any CNS disease deemed to be progressive during the course of the study that may confound the interpretation of the study results. Any clinically significant psychiatric illness, psychological or behavioral problems which, in the opinion of the investigator, would interfere with the subject's ability to participate in the study. Suffering from psychotic disorders and/or unstable recurrent affective disorders evident by use of antipsychotics; subject with current major depressive episode (or within 6 months). A history of alcoholism, drug abuse, or drug addiction within the past 2 years. History of regular alcohol consumption exceeding 2-3 units/day for females and 3-4 units/day for males History of regular use of tobacco or nicotine-containing products exceeding the equivalent of 5 cigarettes per day History of regular consumption of caffeine exceeding the equivalent of 4 cups of coffee per day, a level that approximates health-related criteria Subject has had greater than 2 allergic reactions to an AED or one serious hypersensitivity reaction to an AED. Subjects with more than 1 lifetime suicide attempt or any suicide attempt within the past two years.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ki-Young Jung, M.D, Ph.D
Organizational Affiliation
Seoul National University Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Seoul National University Hospital
City
Seoul
Country
Korea, Republic of

12. IPD Sharing Statement

Citations:
PubMed Identifier
33328106
Citation
Ahn SJ, Kim TJ, Cha KS, Jun JS, Byun JI, Shin YW, Sunwoo JS, Lee S, Yu KS, Jang IJ, Chu K, Lee SK, Jung KY. Effects of perampanel on cognition and quantitative electroencephalography in patients with epilepsy. Epilepsy Behav. 2021 Feb;115:107514. doi: 10.1016/j.yebeh.2020.107514. Epub 2020 Dec 14.
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Effects of Perampanel on Cognition and Electroencephalography in Patients With Epilepsy

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