Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2022; 10(11): 3511-3517
Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3511
Young children with multidrug-resistant epilepsy and vagus nerve stimulation responding to perampanel: A case report
Hua Yang, Dan Yu
Hua Yang, Dan Yu, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yang H wrote the manuscript; Yang H and Yu D collected the data and participated in patient care; Yu D reviewed and edited the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dan Yu, MD, Doctor, Professor, Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu 610041, Sichuan Province, China. yudan540@163.com
Received: August 9, 2021
Peer-review started: August 9, 2021
First decision: November 6, 2021
Revised: November 23, 2021
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Processing time: 242 Days and 5.3 Hours
Abstract
BACKGROUND

Perampanel (PER), a third-generation antiepileptic drug, is a selective and noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist, and has been approved for the treatment of adults and adolescents with focal epilepsy. However, there are only a few studies about the efficacy and tolerability of PER in young children with multidrug-resistant epilepsy. In this case, we aimed to share our clinical experience in this group.

CASE SUMMARY

A 4-year-old boy without perinatal asphyxia and familial history of epilepsy began to have ictal seizures from age 14 mo, with jerky movement of four limbs and head nodding. Abnormal multifocal discharge and background activity were recorded through electroencephalography, and no pathogenic mutation was found in the whole exome sequencing for the patient and his parents. He had received valproate, levetiracetam, topiramate, oxcarbazepine, clonazepam and lacosamide sequentially at different times, but he still had frequent seizures even after vagus nerve stimulation (VNS) implantation. He was diagnosed with idiopathic multidrug-resistant epilepsy. However, his seizure frequency was significantly reduced after PER administration in a dose-dependent manner, and better cognitive behavior was observed. In addition, the adverse reactions of anger and aggression also appeared.

CONCLUSION

PER is effective as add-on therapy for young children with multidrug-resistant epilepsy who have previously undergone VNS implantation.

Keywords: Perampanel; Young children; Drug-resistant epilepsy; Vagus nerve stimula-tion; Case report

Core tip: We report a 4-year-old boy with multidrug-resistant epilepsy who still had frequent seizures after vagus nerve stimulation (VNS) implantation, and he showed significant response to perampanel (PER) as add-on in a dose-dependent manner. Considering its favorable cognitive profile and the similar efficacy and safety profile of PER in children aged < 12 years as in older people, we proposed that the use of PER as add-on could further reduce the seizure frequency for young children with drug-resistant epilepsy and even after VNS implantation, which may be attributed to its novel antiepileptic mechanism.