Perampanel-induced, new-onset food aversion in a 29-year-old female with medically refractory frontal lobe epilepsy

Abstract

Background Perampanel is a selective, noncompetitive amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid glutamate receptor antagonist indicated for management of partial-onset and primary generalized seizures in epilepsy patients aged ≥12 years. Patient History A 29-year-old, white female with significant history of medically refractory frontal lobe epilepsy, status post right frontal and temporal resections, was initiated on perampanel as an add-on therapy to phenytoin extended-release (330 mg/d) and clonazepam (2.5 mg/d). She previously failed several antiepileptic drugs because of inefficacy and/or intolerance. Perampanel was initiated at 2 mg/d and the dose was increased by 2 mg/d increments every 2 to 3 weeks. Following the first dose, nausea and drowsiness were reported but resolved the following day. Three days after titration to 6 mg/d, the patient developed complete food aversion and became more irritable and anxious while no seizure frequency improvement was noted. No change of sense of taste was reported. After reduction to 4 mg/d, adverse effects improved but did not completely resolve until 2 months following perampanel discontinuation. Review of Literature A PubMed search revealed no published literature or case reports of perampanel-induced food aversion or anorexia in a presence or absence of phenytoin and clonazepam. Conclusion In this report, a temporal relationship was observed between perampanel dose-increase and the development of food aversion. Return to baseline appetite and eating habits following perampanel discontinuation strongly suggest perampanel involvement. At this time, the exact mechanism(s) behind food aversion associated with perampanel is/are unknown.

GBAPerampanel Monotherapy- A Novel Treatment for Seizures: A Systematic Review

“…PER ceases the agitation state of Glutamate and disrupts the epileptiform activity at postsynaptic excitatory synapses by imbibing to AMPA receptors [2]. PER has gained a current approval for monotherapy of treating focal-onset seizures with or without secondarily generalized seizures, and as an adjuvant therapy with concomitant AEDs for primary generalized seizures in patients aged older than 12 years [3].…”